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Like the legendary Gordian
knot, the issue of physician in-volvement
in judicial executions
is an entanglement of admin-istrative
agencies, the courts,
the legislature, and conflicting
public policies within our state.
For its part, the Board has at-tempted
to solve this dilemma
by harmonizing the ethics of the
medical profession, the Board’s
disciplinary authority, and the
statutory requirements for execu-tions.
Those considerations can
be summarized as follows.
• Two thousand years of medical principles and the AMA
Code of Ethics state that physician participation in execu-tions
is unethical.
• North Carolina law authorizes the Board to discipline doc-tors
for unethical behavior.
• The warden of Central Prison is required to have a physi-cian
present during executions.
Since the issue has been in the news occasionally in the past
year, I thought some of you might be interested in learning
how we arrived at the doorstep of this conundrum.
In This Issue of the FORUM
forum N C M E D I C A L B O A R D
Primum Non Nocere No. 3, 2007
Item Page Item Page
President’s Message
Primum Non Nocere
NORTH CAROLINA
MEDICAL BOARD
April 15, 1859
H. Arthur McCulloch, MD
Physician Participation in Executions:
The Gordian Knot of the Medico-Legal Arena
In April 2006, the Board received a complaint alleging
that a physician was scheduled to participate in an execution.
Upon investigation, it was determined, based on representa-tions
by the Department of Correction, that no physician had
previously participated in an execution, nor was there any plan
for physician participation in upcoming executions. Shortly
following that complaint, the Board received several inqui-ries
from physicians licensed by the Board, asking about the
Board’s position on physician involvement in executions.
Realizing that the issue of physician involvement in execu-tions
would recur, the Board decided it was appropriate to
consider a Position Statement addressing the ethics and dis-ciplinary
consequences of such physician involvement. After
deliberation by the Board, a public hearing, and the publish-ing
of a draft statement in the Forum, a Position Statement
was adopted this past January.*
Since we had been assured by authorities that the physician
of the penitentiary was merely present and had no active role,
the Board’s Position Statement sought to enforce the ethics
of the profession up to the point that the legislature limited
our authority. Thus, we clarified our recognition of state law
and the requirement for the presence of a physician but gave
notice that active participation could result in discipline. The
Position Statement does not express an opinion on the issue
of capital punishment generally, nor was it intended as an in-
President’s Message
Physician Participation in Executions:
The Gordian Knot of the Medico-Legal Arena.............................1
*H. Arthur McCulloch, MD
Improving Your Practice Management Through
Outsourcing: Part I—Managed Care Contracting
and Billing and Collections.....................................................3
*Marjorie A. Satinsky, MA, MBA
Physician, Protect Thyself!..........................................................6
*A North Carolina Physician
Tamper-Proof Prescription Pads Mandate
Postponed until April 1, 2008..............................................9
*Nancy H. Hemphill, JD
The Controlled Substances Reporting System:
A Useful Tool for Practitioners............................................10
*Nancy H. Hemphill, JD
Candidates Sought for Membership on
Medicaid Drug Utilization Review Board............................11
*Glenda Adams, PharmD, RPh
NCMB Policy Committee Continues
Study of Position Statements...............................................11
General Assembly Makes Historic Changes
to Medical Practice Act........................................................12
*Thomas W. Mansfield, JD
Governor Appoints Thelma C. Lennon, of Raleigh,
to North Carolina Medical Board.........................................14
Board Actions: 05/2007-07/2007............................................15
Change of Address...................................................................24
Compliance Reviews for Nurse Practitioners and
Physician Assistants in North Carolina..................................24
Board Calendar.................................................................................24
General Assembly Makes
Historic Changes to MPA
Page 12
NCMB Forum
North Carolina Medical Board
The Forum of the North Carolina Medical Board is published four
times a year. Articles appearing in the Forum, including letters and
reviews, represent the opinions of the authors and do not necessarily
reflect the views of the North Carolina Medical Board, its members or
staff, or the institutions or organizations with which the authors are af-filiated.
Official statements, policies, positions, or reports of the Board
are clearly identified.
We welcome letters to the editor addressing topics covered in the
Forum. They will be published in edited form depending on available
space. A letter should include the writer’s full name, address, and tele-phone
number.
forum N C M E D I C A L B O A R D
Raleigh, NC Vol. XII, No. 3, 2007
H. Arthur McCulloch, MD
President
Charlotte
Term expires
October 31, 2008
Janelle A. Rhyne, MD
President Elect
Wilmington
Term expires
October 31, 2009
George L. Saunders, III, MD
Secretary
Shallotte
Term expires
October 31, 2009
Ralph C. Loomis, MD
Treasurer
Asheville
Term expires
October 31, 2008
Donald E. Jablonski, DO
Etowah
Term expires
October 31, 2008
Thelma C. Lennon
Raleigh
Term expires
October 31, 2008
John B. Lewis, Jr, LLB
Farmville
Term expires
October 31, 2007
Robert C. Moffatt, MD
Asheville
Term expires
October 31, 2007
Michael E. Norins, MD
Greensboro
Term expires
October 31, 2007
Peggy R. Robinson, PA-C
Durham
Term expires
October 31, 2009
Sarvesh Sathiraju, MD
Morganton
Term expires
October 31, 2007
R. David Henderson, JD
Executive Director
Publisher
NC Medical Board
Editor
Dale G Breaden
Associate Editor
Dena M. Konkel
Street Address
1203 Front Street
Raleigh, NC 27609
Mailing Address
PO Box 20007
Raleigh, NC 27619
Telephone
(919) 326-1100
(800) 253-9653
Fax
(919) 326-0036
Web Site:
www.ncmedboard.org
E-Mail:
info@ncmedboard.org
PrimumNon Nocere
NORTH CAROLINA
MEDICAL BOARD
April 15,1859
Primum Non Nocere
2
strument for halting executions. Rather, it is targeted
at the narrow issue of the ethical implications of phy-sician
involvement in executions.
After the Board issued the Position Statement, the
pot continued to boil when lawyers for several con-demned
inmates filed for a temporary restraining or-der
on grounds that their clients’ constitutional rights
to an execution free of undue pain and suffering were
being violated. The resulting court action stayed sev-eral
scheduled executions.
In response, the Department of Correction revised
the Execution Protocol to include the requirement
that a “doctor shall monitor the essential body func-tions
of the condemned inmate and shall notify the
Warden immediately upon his or her determination
that the inmate shows signs off undue pain or suffer-ing.”
The use of a processed EEG monitor (BIS) is
also included. This revision was done without con-sultation
with the Medical Board, the Medical Soci-ety,
or the physicians of the penitentiary.
As the issue developed, the Department of Correc-tion
filed a lawsuit against the Board, alleging that
executions are not medical procedures and, thus, the
Board cannot discipline a physician for participat-ing.
However, the Medical Practice Act authorizes
the Board to discipline its licensees for misconduct
regardless of whether or not it involves a medical
procedure. Indeed, the Board frequently disciplines
physicians for non-medical conduct, eg, boundary
violations, violations of patient confidentiality, and
disruptive behavior. The authority of the Board to
enforce the ethics of the medical profession is impera-tive
for protection of the public safety and well-being
and for maintaining the integrity of, and public trust
in, the medical profession.
Significantly, the Department of Correction has not
challenged the Board’s conclusion that active physi-cian
participation in executions is unethical. Rath-er,
the judge has made an initial determination that
the Board does not have the authority to discipline
a physician for active involvement in executions. At
the time of this writing, the Board is filing an appeal
from that decision. Meanwhile, in a separate proceed-ing,
another judge has ordered that the Council of
State reconsider the Execution Protocol.
It is difficult at this time to forecast whether this
entanglement will ultimately be resolved by the judi-cial
or legislative sword. However, whether the courts
or the legislature agree with the Board or decide to
limit the Board’s disciplinary authority in some man-ner,
the fact will remain that physician participation
in executions is unethical.
______________________
*The Board has 30 Position Statements that serve as inter-pretive
guides on a variety of topics important to physicians.
These typically come about as a response to complicated ques-tions
of conduct brought to the Board’s attention through
complaints and inquiries. They are intended to provide a safe
harbor for licensees from disciplinary action by the Board.
If you are like most phy-sicians
in private practice,
you know that running your
business can sometimes seem
as challenging as practicing
medicine. Even if you have
supplemented your clinical
training with a business de-gree,
you realize that you are
dealing with a wide variety
of issues that include quality
of care, patient satisfaction,
financial management, peo-ple,
and supporting information technology.
My clients tell me that the longer they practice, the
more complicated practice management becomes. Man-aged
care companies and government payers continue
to impact your revenue in unpredictable and usually
negative ways. Patients expect more from their physi-cians
and don’t hesitate to say so. You keep operating
expenses at a reasonable level by asking your staff to
assume more responsibilities. If you are a small practice
with 10 or fewer physicians, your practice manager, if
you have one, may be deluged with the details of day-to-
day operations. The very thought of taking respon-sibility
for special projects that require a new knowledge
base may be overwhelming.
You may be able to improve the management of your
practice by outsourcing one or more functions that re-quire
specialized expertise that you don’t have and are
unlikely to hire. In this two-part article, I review five
functions that you may be able to outsource to your
advantage: managed care contracting, billing and col-lections,
information technology, human resources, and
financial planning. For each of these areas, I identify
the problems that outsourcing may help you address,
review the advantages and disadvantages of outsourc-ing,
and offer helpful hints for selecting a vendor or
consultant to help you. In this first part of the article, I
deal with managed care and billing and collections. In
the second part, which will appear in the next number
of the Forum, I’ll cover information technology, human
resources, and financial planning.
Managed Care
Let’s face it—physicians would be happy if managed
care would go away. For the time being, however, man-aged
care is here to stay, and for most practices, it ac-counts
for a very large proportion of practice revenue.
Although revenue from managed care contracts is very
No. 3 2007 3
Ms Satinsky
Improving Your Practice Management Through
Outsourcing: Part I—Managed Care Contracting and
Billing and Collections
Marjorie A. Satinsky, MA, MBA
President, Satinsky Consulting, LLC
important for most physician practices, ask any group
of practice managers how they handle managed care
and you’ll get a similar response. Most managers hate
it, avoid it, and rarely give it the attention that it war-rants
given its place as the financial foundation of the
practice. Here’s what I see on a regular basis.
• Many practices don’t know which managed care con-tracts
they have in place, when they last negotiated
these agreements, the contract terms, and the financial
obligation of the payers. It goes without saying that
if you don’t know what you have, you can’t determine
whether or not your situation is good or bad.
• Although North Carolina requires payers to give pro-viders
CPT-code-specific reimbursement for the most
frequent 30 codes annually (and for the full list of
codes upon request), many practices don’t ask for this
information. If I ask about their reimbursement level,
physicians and practice managers tell me they’ll check a
recent sample of payments by the plans. Unfortunately,
that type of check won’t tell me if the actual payment
matches the expected payment as stated in the contract
between the plan and the practice.
• Although many practice management systems have
features that compare actual with expected reimburse-ment,
many practices don’t recognize the importance
of using this function. Well-run practices make this
comparison regularly by automatically checking each
remittance when it comes in or by running a regular
report.
• As one managed care representative said to me, “We
generally don’t go out and offer to pay physicians more
money. If you want an increase, you have to ask for it.”
There are occasional across-the-board fee increases, but
in most cases, physicians must take the initiative.
• Each managed care plan has a unique method of re-imbursement.
Some plans pay a fixed percentage of
Medicare, but not all plans relate this percentage to
the same Medicare year. Other plans use proprietary
fee schedules. It’s difficult to compare reimbursement
across plans—unless you know what information you
need and how to make the comparison.
• Although one might think that all physicians receive
the same amount of money for the same services, that’s
not how it works. The size of your practice, your loca-tion,
and your importance to the network in which you
participate are all contributing factors.
Outsourcing your managed care to a consultant who
looks at both rates and contract language makes sense
for the following reasons.
• Consultants that represent multiple clients have work-ing
relationships with the managed care plans. They
know whom to call at each plan and how to frame the
“You may be
able to improve
the manage-ment
of your
practice by out-sourcing
one or
more functions
that require
specialized
expertise”
4 NCMB Forum
request for a rate increase in a way that is most likely to
get a favorable result.
• Contract language review is a tedious task. You must re-view
not only the legal agreement, but also information
that is contained in detailed administrative manuals and
extensive Web sites. Consultants with experience in re-viewing
and organizing this information into an easily
understandable format can save you hours of reading
and analysis.
• Depending on your selection of a managed care consul-tant,
you can pick someone who will teach your staff
what to do. Once you learn the steps, you can decide
whether or not you want to ask the consultant to do all
your contracts or teach your staff how to do the work.
I see only one disadvantage with outsourcing man-aged
care contracting. If you engage a consultant that
insists on doing all the work for you without teaching
you how to do it yourself, you’ll set up a dependency re-lationship
that you may not need or want in the future.
If you want to outsource your managed care con-tracting,
here are questions you should ask potential
consultants.
1. What is your experience with managed care contract
review and rate negotiations? Consultants vary in
their experience. Some have been doing managed
care work for many years, and others are relatively
new at the game.
2. What kind of practices has the consultant represented?
Every practice is different, so look for a seasoned con-sultant
who has worked with practices in your spe-cialty.
3. Is the consultant willing to work with you on some
but not all of your managed care contracts? It is im-portant
to know what all the plans are paying you,
but in some instances, the reimbursement is fine as
it is. Some consultants insist that they work on each
and every managed care contract that a practice has in
place; others are amenable to working on those that
the practice believes are the most important.
4. How will the consultant work with your practice?
Consultants come in three varieties. “Messiahs” do
the work for you; they save the day. Other consul-tants
convince you that you can’t get along without
them—ever. You are best off with a consultant who
fosters a collaborative relationship with your practice.
Let the consultant teach you what he/she is doing, and
then decide if you want to farm out all of the work or
do some of it yourself.
5. How will the consultant charge you for the service?
The most common methods for pricing managed care
consultation are on an hourly basis or by the project.
In my experience as a consultant, it is hard to predict
how many hours each project will take. I know the
average number of hours I spend reviewing contracts,
administrative manuals, and Web sites, but I don’t
know when I begin a project for a new client how long
it will take me to organize baseline information. I also
can’t predict how many rounds of negotiations will be
required to reach a mutually acceptable conclusion.
6. What do references say about the consultant? You
can’t ask other practices about reimbursement rates,
but you can ask about overall results, accessibility, and
timely response to your needs. You don’t want a con-sultant
who has so many other clients that you don’t
get the attention for which you have paid. You can
also ask the North Carolina Medical Society or your
state professional organization for suggestions.
Billing and Collections
You’ve probably heard the term “revenue cycle man-agement.”
You need to set your fees at an appropriate
level, negotiate your managed care contracts to bring
in reasonable reimbursement, and make sure that your
billing and collections processes support your efforts.
Even if you regularly reevaluate your fee schedules and
renegotiate your managed care contracts, the billing
and collections portion of the revenue cycle process may
malfunction, causing receivables to skyrocket. Here are
the problems that I commonly see.
• In many practices, billing and collections is account-able
to a practice manager who lacks the experience to
supervise the function. Many practice managers began
their careers in clinical positions and worked their way
up the ranks. If their previous responsibilities never
included billing and collections, they may lack the ex-pertise
to supervise the billing and collections staff.
• High staff turnover is another common problem. Let’s
face it; asking for money all day long, primarily over
the telephone, can be a frustrating experience. In my
years as a practice management consultant, I’ve met
only one collections person who loved what she was
doing. In dealing with patients, as opposed to payers,
she actually functioned somewhat as a social worker. If
burnout in your billing and collections staff is common,
it is costly to your practice to repeatedly recruit, hire,
and train—over and over again.
• Inability to focus is a common problem. In many small
practices, the billing and collections staff multi-task, and
they may not focus on the billing and collections aspect
of their job with the concentration needed to get the
job done. I’ve seen practices where the billing and col-lections
people are not methodical in the way in which
they organize their work. Rather than batch the unpaid
claims for a single payer, they call or e-mail about indi-vidual
claims, dragging out the resolution process.
• Billing and collections staff may lack good working re-lationships
with payers. Payers are more responsive to
problems if they are consistently dealing with a single
individual from your practice rather than with multiple
people.
• Self-pay by patients is becoming more and more im-portant
for several reasons. Employers are shifting the
burden of health insurance to employees, and some
are now opting for health savings accounts. People
who are between jobs or are self-employed may have
no health insurance at all. Many practices have a long-standing
tradition of not asking patients for money, and
staff may have trouble transitioning to a different mo-dus
operandi that requires payment at time of service.
Outsourcing billing and collections has both advan-
“In many prac-tices,
billing
and collections is
accountable to a
practice man-ager
who lacks
the experience
to supervise the
function”
No. 3 2007 5
tages and disadvantages. The following are the advan-tages.
• You may reduce your accounts receivable and bring
more revenue into your practice sooner than you are
doing now.
• Within your practice, you can focus on clinical care, not
billing and collections.
• You’ll have access to experts in coding, management,
and insurance who will focus on these tasks and not be
diverted by other pressing needs.
• Staff turnover and the accompanying costs of recruit-ing,
hiring, and training new staff may decrease.
• As physician owners of your practice, you’ll have more,
not less control over billing and collections processes
than you would if these are dependent on your in-house
personnel—who keep leaving.
• You free up space previously taken up by billing hard-ware.
• You can reduce the number of phone calls about billing
and collections that come directly into your practice.
Billing and collections companies answer the phone
with your practice name, so patients do not think their
calls are being diverted.
• You increase the hours of coverage for questions related
to billing and collections.
Outsourcing billing and collections can have three
disadvantages. You can anticipate and address all of
them.
• Your practice manager may be very threatened by the
outsourcing of billing and collections. If, however, the
decision to outsource allows more time to concentrate
on other projects, he/she may welcome the approach.
• Your practice may feel as if it has lost control over its
receivables. Indeed you do give up the responsibility
for day-to-day aspects of billing and collections, but
you don’t give away your responsibility to direct your
vendor in how the work is done. Here’s an example:
the vendor sends letters to patients who don’t pay, and
your practice, not the vendor, should write those letters
and decide when to send them..
• As you plan the information technology support for
your practice (ie, practice management system, elec-tronic
health records—EHR, and/or functional Web
site), you should be looking at a practice management
system and an EHR system that are integrated (ie, built
off the same operating platform). If the vendor that
you select for outsourcing your billing and collections
uses a practice management system that does not have
EHR or that has an EHR system that you do not like,
you will limit your choice of information technology
applications that appropriately support your practice.
If you would like to explore outsourcing billing and
collections, here are questions you can ask potential ven-dors.
1. Is the vendor independently owned or a subsidiary
of another organization? One of my clients that had
previously been managed by a hospital and that had
bought the practice back ruled out a potential vendor
because that vendor was owned by a hospital.
2. What are the vendor’s history and future plans?
3. How does the vendor service new clients? Does it
add new staff or assign additional clients to current
staff?
4. What is the vendor’s attitude toward practices of your
size and specialty? Some vendors are only interested
in large practices, so make sure you ask this question
early in your discussions so you can rule out vendors
that won’t meet your needs.
5. What practice management system does the vendor
use? Most vendors will ask you to use the particular
practice management software that they use. Some
will give you options. One of my clients selected
a billing and collections vendor that used the same
practice management system that was already in
place and found the transition relatively easy.
6. Can you check vendor references and make a site visit
to client sites to see how the system works from the
client’s perspective?
7. Can you visit the vendor’s site and meet the staff that
will handle your account? I accompanied one client
on two vendor site visits. The experience level and
professionalism of one vendor clearly outshone that
of the other and contributed to the final selection.
8. Check on staffing. Who will handle your account,
and what is the staff turnover? Is there a certified
coder on site?
9. How does the vendor charge? Some vendors charge
a percentage of net collections and others charge a
flat monthly fee. What is the fee for software licens-ing
and set-up? What will you spend on hardware
and connectivity?
10. Is staff training included in the start-up fee or is it
extra? How does the vendor charge for ongoing
training?
11. Will the vendor help you clean up past claims, and
if so, will this service be included or will there be an
extra charge?
12. What is the vendor’s target for accounts receivable?
You should be able to get targets for percentage of
claims over 90 days old and for average days in re-ceivables.
13. Given your particular situation, what financial savings
does the vendor expect to produce for your practice?
14. What are the details of the transition process and how
long will it take?
15. How frequently will the vendor meet with your prac-tice?
16. What reports will you get on a regular basis? If the
practice management system that the vendor uses
does not produce clear reports that can help your
practice, you may find yourself struggling to under-stand
the financial health of your practice.
………………………………
Acknowledgements
Karen Diamond, CFP, CIMA, and Ed Barber, CFM, formerly
with Merrill Lynch; and Jean Bailiff, Physician Discoveries.
__________________________
Ms Satinsky is president of Satinsky Consulting, LLC. She earned
her BA in history from Brown University, her MA in political science
from the University of Pennsylvania, and her MBA in health care
administration from the Wharton School of the University of Penn-
“Outsourc-ing
billing
and collections
can have three
disadvantages.
You can an-ticipate
and
address all of
them”
6 NCMB Forum
sylvania. She is the author of three books: Medical Practice Man-agement
in the 21st Century (Radcliffe Publishing, 2007), The Foun-dation
of Integrated Care: Facing the Challenges of Change (American
Hospital Publishing, 1997), and An Executive Guide to Case Manage-ment
Strategies (American Hospital Publishing, 1995). The Forum
has published several articles by Ms Satinsky, including Managing the
Implementation of HIPAA and the Privacy Rule, in #4, 2002; How
to Determine If Your Practice Could Use a Professional Practice Ad-ministrator,
in #2, 2003; Using Information Technology to Improve
Patient Care and Communication: A Practical Guide – Part 1, in #1,
2004; Using Information Technology to Improve Patient Care and
Communication: A Practical Guide – Part 2, in #2, 2004; Electronic
Medical Records and the Development of Electronic Health Records
and Electronic Patient Records, in #3, 2004; Implementation of the
HIPAA Security Rule in #4, 2004; What Are You Doing About
Health Care Quality in Your Practice, Part I, #1, 2006 and Part II,
#2, 2006. An adjunct faculty member at the University of North
Carolina School of Public Health, Ms Satinsky is a member of the
North Carolina Medical Society Quality of Care and Performance
Improvement Committee, Medical Group Management Associa-tion,
and North Carolina Medical Group Managers. She may be
reached at (919) 383-5998 or margie@satinskyconsulting.com.
Physician, Protect Thyself!
A North Carolina Physician
I am a physician in North Carolina, board certified
in anesthesiology and pain management. I trained
at one of the best medical schools in the country and
completed an excellent residency program. I served
honorably as an officer in the armed services. After
coming to North Carolina, I built a successful practice
and found a great deal of satisfaction in helping pa-tients
with severe pain.
The physician who offers pain management care to
his/her patients discovers very quickly that the patients
being seen are generally extremely ill. These patients
suffer chronic, debilitating pain, and in many cases pal-liative
care is offered where there is no other meaning-ful
care or cure available. The “symptom” of severe
pain, which often accompanies trauma or disease like
cancer, finally becomes the primary disease, at least in
terms of what may be treatable.
We all became physicians in order to help others, to
offer care and solace to our patients. Our patients in
pain come to us for that help, and they often demand
much from their physicians. Often, it becomes dif-ficult
for the physician to maintain the clear, definitive
boundaries that are so necessary to keep both the pa-tient
and the physician healthy and productive.
Neglecting My Own Well-Being
In the area where I practiced, there were few pain
management physicians; this is, unfortunately, the case
in many counties in North Carolina. Patients, driven
by the agony and frustration of unrelenting pain, of-ten
seek relief from nonphysicians, or from foreign
markets. Most of the time, these “treatments” don’t
work—the treatment may actually exacerbate the
pain—and the patient is forced once again to try an-other
remedy. There is an overwhelming need in these
people’s lives for some—any—relief from pain.
As a “workaholic,” I put no limitations on the de-mands
I made of myself or the demands I allowed oth-ers
to make of me. I saw patients long into the evening,
resulting in excessively long workdays. If there had
been 36 hours in the day instead of 24, I could have
filled that time with more patients. I had medical staff
privileges at two hospitals and saw walk-in patients
at both hospitals. I was willing to drive hundreds of
miles each week to visit patients; back and forth, be-tween
the two facilities daily. In addition, I took call
(much of it involving my post-surgical patients) and
attended to my busy office practice. I played the role
of Superman. When other physicians had cases that
no one else could or would handle, I was the “go-to”
pain management specialist. The more difficult the
challenge, the more quickly I accepted it. I wanted
above all to make a difference in my patients’ lives;
unwittingly, I was setting myself up for a fall.
It was impossible to schedule my days and nights in
this way without ignoring my own well-being. Grad-ually,
I lost sight of those necessary and appropriate
boundaries between my personal life and professional
life. My entire life was out of control, but I was so
busy, so tired, so stretched that I wasn’t even aware of
it. As events continued to spiral more and more out
of control, I thought, of course, everything remained
under my control.
Eventually, my hectic lifestyle resulted in behavior
that was erratic enough to attract the attention of a
person who, erroneously, reported me to the admin-istration
of one of the hospitals as being on drugs.
When approached by a North Carolina Physicians
Health Program (NCPHP) member, I not only de-nied
the charge but was quite upset that I had been
turned in; I certainly was not a user or abuser of drugs!
Thank you, NCPHP, but I can handle this myself, I
thought. Unfortunately, my way of handling the situa-tion
was not to cut my work load or take care of myself
personally.
Of course, the fact that I knew I wasn’t on drugs
didn’t keep the gossipers from continuing to talk: my
lifestyle was as chaotic as ever, my demeanor just as
frenetic, and I’m sure, in hindsight, that I was missing
cues right and left that I was being watched. If some
of the folks watching me were waiting for me to prove
I was taking drugs, it didn’t happen. But if they were
waiting for me to prove I was in trouble, I gave them
all the proof they needed.
In what was an out of the blue scenario for me, I
was notified that my staff privileges at one of the two
hospitals where I practiced had been summarily sus-pended.
It was felt that I was a serious danger to pa-
“Gradually,
I lost sight of
those necessary
and appropri-ate
boundaries
between my per-sonal
life and
professional
life”
No. 3 2007 7
tients, they said. Me? A danger to patients? I took
great care of my patients and they cared for me. I
didn’t understand; surely there must be some mistake.
Charges were levied that were biased, based on gos-sip,
and untrue! To add insult to injury, the hospital
notified the North Carolina Medical Board and the
National Physicians Data Bank within two hours of
notifying me. Almost immediately, the Medical Board
requested that I voluntarily surrender my medical li-cense.
I had not yet realized the consequences of years
of neglect of my own well-being. My chaotic personal
life and unrealistic professional demands had caught
up with me. But at that time I felt my life was crash-ing
down around me. I had never been so angry, so
frustrated, so alone, and so afraid. How could this be
happening to me?
Learning to Concentrate on Me
Thankfully, at a time I felt I couldn’t fall any further,
a miraculous new experience presented itself and lifted
me up. Through my attorney, I reestablished contact
with the NCPHP. As I mentioned, I had an earlier en-counter
with the NCPHP, when I was sure I didn’t
need any help! I am deeply grateful that they still had
faith in me. With the encouragement of the NCPHP, I
entered an inpatient treatment facility, and there began
the miracle. For the first time in years, I was able and
encouraged to concentrate on ME.
I came to understand and accept what I had been
doing to myself. By not keeping myself healthy and
making sure I was enjoying a full and satisfying per-sonal
life, I could not have a productive professional
life. And only by remaining attentive to keeping my
professional life healthy could I offer meaningful care
to my patients. I eagerly embraced the knowledge and
experience of my care providers. I learned more about
what was driving me and recognized that I wasn’t
Superman after all. But I could continue being the
excellent physician I knew I had been. By paying at-tention
to my physical health, my emotional health,
and my spiritual health (not always in that order!), my
demeanor changed without effort. I lost the frantic,
over-extended personality and found the calm, reas-suring
one that instilled, for my staff, my peers and
my patients, a sense of confidence in me. I learned to
properly schedule my work day, keeping in mind how
many hours it actually contains and how much call I’ve
taken.
The charges and claims made against me were, for
the most part, unfounded; but the problem was defi-nitely
there, and even though I wasn’t yet a danger to
patients, it might have been only a matter of time. Too
many patients, too little sleep, a missing report: expe-riences
we have all shared, but in different contexts,
different places.
Betrayal of Trust
Eventually, I regained my North Carolina medical
license with some hourly and surgical limitations that
were gradually lifted. My license is now full and un-restricted.
I opened a new medical practice, and al-though
I was working a much lighter schedule than
before, I soon realized that I needed another employee
to work in the clinical area. In the past, I had several
unsuccessful contract experiences with medical assis-tants
from temporary hiring services, and I finally de-cided
I had to bite the bullet and hire the best clinical
assistant I could afford. I thought a registered nurse
was out of the question, simply too expensive. One
applicant, however, Christine (not her name), was a
former registered nurse who had lost her license due
to substance abuse. Christine led me to believe that
she had completed treatment and was in recovery. She
came highly recommended. I was extremely impressed
with her credentials, and when I met her I found her to
be pleasant, thoughtful, and articulate. I immediately
considered hiring her.
Before hiring Christine, I discussed with her our
practice environment and the safety parameters we
had set up. I was completely frank about my prior
difficulties and I wanted to make sure she understood
the importance of strictly following our practice poli-cies
and procedures. We also talked about her desire
to work in a safe and supportive environment and how
that could assist her in her own recovery. Wanting to
make sure I handled this prudently, and to demonstrate
due diligence, I contacted the Drug Court, which was
in charge of Christine’s rehabilitation program. I
talked to the Judge who was involved in her case to
determine whether he felt Christine would be a good
candidate for the position in my practice. He thought
she’d be a perfect fit. I also sought the opinion of my
Caduceus peers and my local contact with the NCPHP.
Certainly, if anyone I approached had advised me not
to hire Christine, I would have honored that advice.
But, since all parties agreed, Christine’s hire seemed
beneficial for both of us. I hired her with every expec-tation
that would be the case.
My DEA license had not been restricted when I vol-untarily
surrendered my medical license because there
were no issues regarding use or distribution of phar-maceuticals.
Even though my office practice is pain
management, the only controlled drugs kept on the
premises were alprazolam and hydromorphone. Both
were in pill form and sealed in numbered blister packs.
Both medications were kept in the front office, secured
in a double-locked safe. No injectable narcotics were
kept on the premises. This was all explained to Chris-tine.
Christine was never permitted to medicate pa-tients.
She had access to only one prescription book
with numbered prescriptions, for which she was solely
accountable. Each written prescription produced a
carbon copy. No discrepancies occurred. Christine
appeared to adjust quickly to her new job.
After a few months, Christine’s performance, which
had been excellent, began to decline. Her attention
“Christine led
me to believe
that she had
completed treat-ment
and was
in recovery. She
came highly
recommended”
8 NCMB Forum
to detail was failing. This was a gradual process; she
continued to arrive promptly and appeared to have
no problem performing her professional duties. Two
months into her employment, Christine tested posi-tive
on a urine screen required by the Drug Court.
With my office manager, I immediately met with her
to discuss the test results. Christine explained she had
gained weight over Thanksgiving and had been taking
diet pills. She assured us she had absolutely no idea
an over-the-counter diet pill would produce a positive
reading on her urine screen. We both counseled Chris-tine
about avoiding any substance that could test posi-tive.
I also reminded her that it was critical nothing
happen that could jeopardize my career and damage
my new practice. We told Christine in no uncertain
terms that her employment would be immediately ter-minated
if there were another positive urine screen.
She remained an enrollee of Drug Court Phase 3,
and she was continued on a more stringent outpatient
recovery plan as a result of the positive test. To the
best of my knowledge, Christine adhered to all the re-quirements
of her treatment plan, including random
urine toxicology screens.
A month later, Christine had her regular drug screen.
The next day, Christine’s housemate called the office to
report Christine would not be coming in because she
was not feeling well. Later that morning, I received a
call from an emergency room physician. He explained
that he was taking care of Christine and he needed to
know if I was missing any injectable narcotics from
the office. The physician said it was vital to have this
information to properly treat her for an overdose. I as-sured
him that no injectable narcotics were kept in the
office and that our daily controlled substance inven-tory
showed no discrepancies. The ER physician told
me Christine had been given dopamine to support her
blood pressure and Narcan to reverse narcotic over-dose
symptoms. After stabilizing, she was transferred
to a ward bed at the hospital for further monitoring.
A Gap in the System
My office manager and I immediately investigated
possible sources in our office for Christine’s drug ac-cess.
I telephoned the North Carolina Medical Board
to report this incident, as well as the local DEA agency.
An investigator from the local agency visited the office
that same day to evaluate the situation. After meeting
with him, my office manager and I continued to inves-tigate
the possibility of drug diversion from the office.
The local investigator agreed to notify all nearby phar-macies
and ask them to fax me a list of patients that
had been prescribed controlled substances under my
name. I reviewed those but was unable to identify any
unauthorized or fraudulent prescriptions.
It was not until four days later that we discovered
Christine’s source during a routine delivery of office
supplies. Unknown to me or my staff, the delivery
also included six vials of nalbuphine (Nubain). When
my office manager and I reviewed delivery invoices
for existing supplies, we discovered there were six 10
mg vials of Nubain that had been ordered in previous
weeks. These were ordered under the auspices of my
practice. No such orders of Nubain had been autho-rized.
Despite an extensive search, there remained no
accounting for the additional six vials of Nubain.
In due course, it
became clear that
Christine had been
secretly ordering the
Nubain vials. It is
equally clear that no
one else was aware
that the orders had
been placed, let alone
that they had been
diverted. Because
Nubain is not a con-trolled
substance,
no DEA number or
prescription is re-quired.
We discov-ered
that Christine
did not even require
my medical license
number to place orders for Nubain; the fact that the
order came from a medical office was sufficient autho-rization
for the supplier to ship the vials. As a former
RN, Christine was aware of this loophole. She was
also aware that she could time her injections of Nubain
to avoid positive urine test results.
A printed form was routinely used to fax the orders
for supplies. All supplies were ordered by noting the
number requested. Evidently, Christine penciled in
orders for Nubain and then erased the hand-written
entry after receiving the order. After unpacking and
counting the supplies to assure the order was com-plete,
Christine destroyed the accompanying invoices.
We had no reason to believe that her reconciliation of
items ordered to those received differed at all.
Having determined the source of Nubain diversion,
I again contacted the local DEA agent to further in-vestigate
this matter. It seemed incredible to me that
Nubain could be so easily acquired. Nalbuphine is a
synthetic opioid agonist/antagonist and is a potent an-algesic;
its analgesic potency is essentially equivalent
to that of morphine on a milligram basis. It impairs
physical and mental abilities, and physicians are advised
to use extreme caution when prescribing for patients
with former opioid dependencies/addictions.
In addition, Nubain is extremely inexpensive. A 10
mg vial of Nubain costs a mere 79 cents. Therefore,
in the context of invoice payments totaling hundreds
to thousands of dollars, the nominal additional charges
for Nubain could easily escape detection. In hindsight,
this harrowing scenario lends support to the concern
that this drug may be a very popular “drug of choice”
“Evidently,
Christine pen-ciled
in orders
for Nubain
and then erased
the hand-writ-ten
entry after
receiving the
order”
Three days before the
tamper-resistant prescrip-tion
pad requirement was
to go into effect, Congress
passed legislation pushing
back the implementation
date until April 1, 2008.
The new mandate had been
included in a federal budget
bill (Section 7002(B) of
P.L. 110-28, the US Troop
Readiness, Veterans’ Care,
Katrina Recovery, and Iraq
Accountability Appropriations Act of 2007) enacted
in May 2007. Federal guidelines were issued August
17, while the North Carolina Department of Health
and Human Services, Division of Medical Assistance
(DMA), published theirs on September 6, 2007. Fed-eral
law initially set the effective date as October 1,
2007.
Given the extremely short time frame for educating
those affected by it and implementing the act, many
professional associations, health care providers, state
Medicaid directors, and others protested, and appar-ently
Congress listened, delaying the effective date by
six months.
The measure will apply to all handwritten prescrip-
No. 3 2007 9
for those who are in a position to order it, as Christine
did, in any clinical setting. Based on the results of the
narcotics investigation with which my staff and I fully
cooperated, no charges were brought against the prac-tice,
my staff, or me. I kept the Medical Board fully
apprised of the situation as it developed. Nevertheless,
with the continuing advancement, and ease, of elec-tronic
communications and the invitation this presents
to those who would use it to their own advantage, it
becomes even more imperative that the physician pro-tect
herself/himself.
Protecting Precious Gifts
I am very concerned about Christine’s well-being.
However, she endangered others and she placed my
practice and my career at risk, even though I am sure
that was not her intent. In addition, I put myself at
risk without meaning to. While I remain fiercely sup-portive
of other health care providers in recovery, and I
will continue to offer encouragement and assistance to
others in recovery, I simply cannot afford to hire a col-league
in recovery. This isn’t my preference; however,
in weighing the potential risk versus benefit involved
in such a situation, I have determined that I simply
cannot take the risk, primarily because I am a sole
practitioner. Despite a great support system, I have
no “safety net” for my practice; no partners to bridge
the gap in the event I am unable to work for even
a very short time. The financial and emotional toll
of again closing my practice doors is more than I
can even consider. The years after my hospitalization
were not easy. I lost my former medical practice, my
patients, my staff. My home and my financial secu-rity
were lost almost as quickly.
Nevertheless, I am a much happier, healthier, well-balanced
physician today. I am a much more careful
person; I manage my private practice in such a way
that it benefits my patients, my staff, and myself. I
am a happy man, a rare commodity these days. I
take time to engage in hobbies and to seek support
from, and offer it to, others. I recognize my health
and my career as precious gifts that I enjoy and pro-tect
daily.
__________________________
The author wishes to thank Donna Turner Eyster, JD, of
Raleigh, for her assistance in preparation of this article.
Ms Hemphill
Tamper-Proof Prescription Pads
Mandate Postponed until April 1, 2008
Nancy H. Hemphill, JD
NCMB Special Projects Coordinator
tions for recipients of North Carolina Medicaid. The
purpose of the law is to prevent alterations and forger-ies
of prescriptions and to protect the public health by
reducing drug diversion and illegal sales.
The requirement applies to all outpatient drugs, in-cluding
over-the-counter medications, for which state
Medicaid programs provide reimbursement. Excep-tions
include: drugs administered in hospitals, long
term care facilities, medical offices, and other inpatient
health care settings. Prescriptions that are transmitted
by e-mail, fax, or telephone will be acceptable. Refills pre-sented
prior to April 1 do not have to be resubmitted
on the new form. Neither does the law apply when a
managed care facility pays for the prescription. An
emergency prescription written on a non-compliant
form may be filled as long as a compliant prescription
is filed within 72 hours after the prescription is filled.
Out-of-state prescriptions must also meet the require-ment.
From April 1, 2008, until October 1, 2008, prescrip-tion
pads must only contain one out of three elements
of tamper resistance (although they can, of course, ful-fill
more). If a prescription pad meets any one of the
following requirements, its use is acceptable: (1) one
or more industry-recognized features designed to pre-vent
unauthorized copying of a complete or blank pre-scription
form; (2) one or more industry-recognized
“I simply can-not
afford to
hire a colleague
in recovery”
10 NCMB Forum
The Controlled Substances Reporting System:
A Useful Tool for Practitioners
Nancy H. Hemphill, JD
Special Projects Coordinator, NCMB
The North Carolina Controlled Substances Reporting
System (CSRS) went into operation on July 1, 2007. En-acted
by the state legislature in August 2005, the CSRS
requires the North Carolina Department of Health and
Human Services to establish and maintain a reporting
system for all prescriptions for Schedule II, III, IV, and V
controlled substances. It is hoped that the reporting sys-tem
will stem the epidemic of deaths from unintentional
drug overdoses from licit drugs, mostly narcotics. NCGS
90-113.71 states that the bill was “. . .intended to im-prove
the State’s ability to identify controlled substance
abusers and refer them for treatment, and to identify and
stop diversion of prescription drugs in an efficient and
cost-effective manner that will not impede the appropri-ate
medical utilization of licit controlled substances.”
Dispensing pharmacies must now report all of the fol-lowing
to the DHHS: the patient’s name, address, phone
number, and date of birth; the date of the prescription;
the prescription number; whether it’s a new prescription
or a refill; the metric quantity; estimated days of supply;
its National Drug Code; and both the prescriber’s and
dispenser’s DEA numbers. Pharmacies must report the
dispensing of controlled substances at least monthly until
July, 2008; thereafter, the data must be transmitted twice
a month. Physicians, physician assistants, nurse practi-tioners,
and others authorized to administer controlled
substances under NCGS Chapter 90 are not required
to report, even if they dispense these drugs. Other ex-emptions
apply to licensed hospitals or long-term care
facilities dispensing for inpatient use, and to wholesale
distributors of controlled substances.
Access to the state’s electronic data storehouse will be
limited. Those who can write and fill prescriptions will
be allowed access, as will individual patients; the SBI;
the courts (under a court order in a criminal action); the
Division of Medical Assistance; and monitoring authori-ties
from other states pursuant to an ongoing investi-gation.
The North Carolina Medical Board (and other
health care licensing boards) also can obtain the data, but
only if the Board is already conducting an investigation
of a licensee for prescribing irregularities. Note that the
law provides both civil and criminal immunity to licensed
health care providers who, in good faith, report or trans-mit
data pursuant to this law. The law also includes civil
penalties for those who breach its confidentiality provi-sions
or use the information for improper purposes.
Prescribers who wish to receive information from the
CSRS will have to file a one-time application for admis-sion
to the system and will receive a secure password.
While the application is not currently available on line,
it ultimately will be found at www.ncdhhs.gov/mhddsas.
Until then, contact Johnny.Womble@ncmail.net, or (919)
715-2771, ext 248. Once a physician is registered and
approved for access to the database, he or she can check
a patient’s prescription history on line. Physicians who
suspect that a patient is abusing and/or diverting narcot-ics
will finally have an easy and definitive way to verify
narcotic use and curb abuse. Here’s an example of how
this might work. A patient may go to her primary care
practitioner and request a refill for a one-time narcotic
prescription originally provided by her orthopedist.
With the patient still in the office, the physician can go
to his computer, access the CSRS database, and check
the patient’s controlled substance information. If what
the patient reports is true, the physician can write a re-fill.
The pharmacy will then relay the details of that pre-scription
to the database, so if the patient’s orthopedist
chooses to check on the patient, he or she can learn that
a refill was issued.
The physician also can discover whether the patient
features designed to prevent erasure or modification
of information written on the prescription by the
prescriber; or (3) one or more industry-recognized
features designed to prevent the use of counterfeit
prescription forms. Beginning October 1, 2008, pre-scription
pads must contain all three characteristics.
Under each of the three standards, a number of
different anti-tampering features are listed in a DMA
guidance letter. For example, the appearance of the
word “VOID” across the entire front of the prescrip-tion
blank when the prescription is photocopied or
scanned would satisfy the first provision. The second
provision might be met by using chemically treated
ink or paper that resists washing, erasure, and repro-duction.
The third would be met by inserting a one-inch
square logo of the individual, professional prac-tice,
professional association, or hospital on the upper
left corner of the prescription blank.
It is the duty of dispensing pharmacies to ensure
that prescriptions are in compliance with Section
7002(b). North Carolina pharmacists will not be
able to fill non-compliant paper prescriptions because
the Center for Medical Assistance states: “Prescrip-tions
reimbursed by NC Medicaid on noncompliant
prescription pads are subject to recoupment.” It is
likely that pharmacists will be calling physicians ask-ing
them to resubmit prescriptions by phone, fax, or
e-mail.
For more information, go to: www.dhhs.state.nc.us/
dma/prov.htm, and look under “What’s New.”
“Once a physi-cian
is registered
and approved
for access to the
database, he or
she can check a
patient’s pre-scription
history
on line”
No. 3 2007 11
has received narcotic prescriptions from other prac-titioners.
After checking the history of the patient’s
narcotic drug use, the primary care practitioner can
choose whether to counsel her about substance abuse
or take other action. It is hoped that immediate access
to a patient’s narcotic prescription history will be used
Candidates Sought for Membership on
Medicaid Drug Utilization Review Board
Glenda Adams, PharmD, RPh*
The North Carolina Division of Medical Assistance
(DMA) is looking for candidates who would like to be
considered for a North Carolina Medicaid Drug Utiliza-tion
Review (DUR) Board member position.
In accord with the Social Security Act of 1927 and
OBRA of 1990, the DUR program for outpatient drugs
assures that prescriptions to Medicaid recipients are ap-propriate,
medically necessary, and not likely to result in
adverse medical events.
The DUR Board consists of the DMA DUR coordi-nator,
five licensed and actively practicing physicians, five
licensed and actively practicing pharmacists, and two at-large
members with knowledge and expertise in one or
more of the following: prescribing of Medicaid covered
outpatient drugs; dispensing and monitoring of Medicaid
covered outpatient drugs; drug use review, evaluation, and
intervention; or medical quality assurance. Excluding the
at-large members, candidates must actively provide medical
NCMB Policy Committee Continues
Study of Position Statements
The Policy Committee of the North Carolina Medical
Board regularly reviews the Board’s Position Statements
and considers new statements. The Board’s licensees and
others interested are invited to offer comments on any
statement in writing to the chair of the Policy Commit-tee,
by e-mail (info@ncmedboard.org) or post (PO Box
20007, Raleigh, NC 27619). Comments are collected
over time and considered when the relevant statement is
reviewed or considered.
The Policy Committee discusses the Position Statements
in public sessions during regularly scheduled meetings of
the Board. The results are published on the Board’s Web
site and in the Forum before consideration by the Board,
allowing for further written comments to assist the Com-mittee
in preparing a final version for Board action.
Recently, the following statement was proposed for
consideration and comment.
End-of- Life Responsibilities and Palliative Care
Assuring Patients
Death is part of life. When appropriate processes have deter-mined
that the use of life-sustaining life-prolonging measures or
invasive interventions will only prolong the dying process, it is in-cumbent
on physicians to accept death “not as a failure, but the
natural culmination of our lives.”*
It is the position of the North Carolina Medical Board that pa-tients
and their families should be assured of competent, compre-hensive
palliative care at the end of the patient’s life. Physicians
should be knowledgeable regarding effective and compassionate
pain relief, and patients and their families should be assured such
relief will be provided.
Palliative Care
Palliative care is an approach that improves the quality of life
of patients and their families facing the problems associated with
life-threatening illness, through the prevention and relief of suffer-ing
by means of early identification, an impeccable assessment and
treatment of pain, and other physical, psychosocial, and spiritual
problems. Palliative care:
• provides relief from pain and other distressing symptoms;
• affirms life and regards dying as a normal process;
• intends neither to hasten nor postpone death;
• integrates the psychological and spiritual aspects of patient
care;
• offers a support system to help patients live as actively as pos-sible
until death;
• offers a support system to help the family cope during the pa-tient’s
illness and in their own bereavement;
care to Medicaid patients.
The DUR Board meets quarterly in Raleigh, NC
(1:00-3:00 PM, usually on the fourth Thursday of January,
April, July, and October). In meeting months, two hours
are compensated for attending the meeting and up to an
additional two hours for preparing for the meeting. The
preparation for the meeting involves reviewing reports/ar-ticles
that will be discussed at the meeting. In the months
when no meetings are scheduled, there is minimal time
involvement. Mileage is compensated in accordance with
State Budget Regulations (usually current IRS rate).
If you are interested in being notified when there is
a vacancy on the DUR Board or would like additional
information, please send an e-mail to Glenda Adams at
glenda.adams@ncmail.net.
__________________________
*Clinical Pharmacist, Clinical Policy Pharmacy Section, NC Divi-sion
of Medical Assistance.
to assist in proper prescribing and prevent abuse of
controlled substances by individuals who should not
receive them.
__________________________
See also NCGS 90-113.71 through 90-113.76; 10A NCAC
26E .0601 through 10A NCAC 26E .0603.
The North Carolina Gen-eral
Assembly passed sev-eral
bills this summer that
make historic changes to the
Medical Practice Act (MPA).
These changes are the most
comprehensive revision of
the MPA since the Board’s
inception almost 150 years
ago. These new laws resolve
litigation regarding the Board
member selection process,
give consumers more access
to pertinent physician information, remove archaic lan-guage,
reorganize/rewrite sections of the MPA that were
disorganized and confusing, add a much-needed defini-tions
section, specifically enumerate and also expand the
powers of the Board (including the power to enact rules
related to continued competence and the disposition of
medical records), and improve the Board’s ability to con-duct
hearings.
The following are highlights of new provisions. All
changes went into effect October 1, 2007, except the
12 NCMB Forum
• uses a team approach to address the needs of patients and their
families, including bereavement counseling, if indicated;
• will enhance quality of life, and may also positively influence
the course of illness;
• [may be] applicable early in the course of illness, in conjunction
with other therapies that are intended to prolong life, such as
chemotherapy or radiation therapy, and includes those inves-tigations
needed to better understand and manage distressing
clinical complications.**
There is no one definition of palliative care, but the Board ac-cepts
that found in the Oxford Textbook of Palliative Medicine:
“The study and management of patients with active, progressive,
far advanced disease for whom the prognosis is limited and the
focus of care is the quality of life.” This is not intended to exclude
remissions and requires that the management of patients be com-prehensive,
embracing the efforts of medical clinicians and of those
who provide psychosocial services, spiritual support, and hospice
care.
A physician who provides palliative care, encompassing the full
range of comfort care, should assess his or her patient’s physical,
psychological, and spiritual conditions. Because of the overwhelm-ing
concern of patients about pain relief, special attention should
be given the effective assessment of pain. It is particularly impor-tant
that the physician frankly but sensitively discuss with the pa-tient
and the family their concerns and choices at the end of life.
As part of this discussion, the physician should make clear that, in
some cases, there are inherent risks associated with effective pain
relief in such situations.
Opioid Use
The Board will assume opioid use in such patients is appropri-ate
if the responsible physician is familiar with and abides by ac-ceptable
medical guidelines regarding such use, is knowledgeable
about effective and compassionate pain relief, and maintains an ap-propriate
medical record that details a pain management plan. (See
the Board’s Position Statement on the Management of Chronic
Non-Malignant Pain Policy for the Use of Controlled Substances
for the Treatment of Pain for an outline of what the Board expects
of physicians in the management of pain.) Because the Board is
aware of the inherent risks associated with effective pain relief in
such situations, it will not interpret their occurrence as subject to
discipline by the Board.
Selected Guides
To assist physicians in meeting these responsibilities, the Board rec-ommends
Cancer Pain Relief: With a Guide to Opioid Availability,
2nd ed (1996), Cancer Pain Relief and Palliative Care (1990), Can-cer
Pain Relief and Palliative Care in Children (1999), and Symp-tom
Relief in Terminal Illness (1998), (World Health Organization,
Geneva); Management of Cancer Pain (1994), (Agency for Health
Care Policy and Research, Rockville, MD); Principles of Analgesic
Use in the Treatment of Acute Pain and Cancer Pain, 4th Edition
(1999)(American Pain Society, Glenview, IL); Hospice Care: A
Physician’s Guide (1998) ( Hospice for the Carolinas, Raleigh); and
the Oxford Textbook of Palliative Medicine (1993) (Oxford Medical,
Oxford).
(Adopted 10/1999; amendment proposed 5/2007)
*Steven A. Schroeder, MD, President, Robert Wood Johnson
Foundation.
** Taken from the world Health Organization definition of
Palliative Care (2002): (http:www.who.int/cancer/palliative/defini-tion/
en)
General Assembly Makes Historic Changes
to Medical Practice Act
Thomas W. Mansfield, JD
Director, Legal Department
Legislative Liaison
Mr Mansfield
Board member selection process provisions, which go
into effect January 1, 2008.
Board Member Selection Process
While the Governor has made the final decision regard-ing
appointments of physician members to the Board, the
North Carolina Medical Society (NCMS) provided the
nominees from which the Governor was required by stat-ute
to choose. The Board and the people of North Caro-lina
benefitted from the relationship between the Board
and the NCMS, but there was a great deal of criticism
from consumer advocacy groups, the media, and others
regarding the appointment process.
House Bill 8181 creates an independent Review Panel
that will make recommendations to the Governor regard-ing
appointments to seven physician seats and one seat held
by a physician assistant or nurse practitioner.2 The Review
Panel will make at least two recommendations for each
seat, and the Governor will pick from those recommen-dations.
The Review Panel will consist of nine members.
Eight of those members will be selected by the NCMS,
Old North State Medical Society, NC Osteopathic Medi-cal
Association, NC Academy of Physician Assistants, and
“There was a
great deal of criti-cism
from con-sumer
advocacy
groups, the media,
and others regard-ing
the appoint-ment
process”
No. 3 2007 13
NC Nurses Association Council of Nurse Practitioners.3
The ninth member will be one of the public members cur-rently
serving on the Board. Membership on the Board
does not require membership in any of the organizations
participating in the review and recommendation process.
House Bill 818 does establish other criteria for phy-sician
Board membership. Those criteria include having
an active license in good standing with the Board, hav-ing
an active clinical or teaching practice, having practiced
clinically for five years preceding appointment, providing
letters of recommendation, having no disciplinary history
with any medical board in the preceding 10 years, and hav-ing
no felony criminal convictions and no misdemeanor
convictions involving the practice of medicine. Applicants
must certify they understand that the Board’s purpose is to
protect the public, that they are willing to take disciplinary
action against their peers when appropriate, and that they
understand the significant time commitment required of
Board members.
Consumer Access to Physician Information
House Bill 818 also authorizes the Board to collect cer-tain
information from physicians and make it available to
the public. This will be in the form of a “physician profile”
system. The Board currently publishes on its Web site sig-nificant
information about its licensees in a user-friendly
format. That information will be expanded to include area
of practice, disciplinary actions by other medical boards
and agencies, felony and certain misdemeanor criminal
convictions, certain suspensions or revocations of hospital
privileges, and some information about professional liabil-ity
(so-called “malpractice”) payments. Failure by the phy-sician
to provide the required information to the Board
may result in disciplinary action.
The Board has spent much of the last year carefully
studying the issue of publishing information about profes-sional
liability payments. The Board cannot begin publish-ing
the payment information until it creates rules regard-ing
how the information will be collected and published.
The rulemaking process will take some months. Licensees
should pay close attention to the Forum for updates.
Reorganization, Codification, and Licensing
House Bills 818 and 13814 reorganize the licensing
provisions of the MPA and codify in the statute many pro-visions
previously covered specifically only by rule. Now,
the reader of the MPA can more easily find the licensing
provisions of the law. Archaic and outdated provisions are
deleted.
There are only two entirely new concepts in the licens-ing
laws. One is the requirement that all applicants for a
license be able to communicate effectively in the English
language. The other new concept is in the creation of a
Special Purpose License, which may serve several purpos-es
but was born of the need to facilitate bringing in excel-lent
physicians practicing in other states to North Carolina
on a temporary basis to consult with and teach our own
licensees.
Definitions
Section 1 of House Bill 818 creates an expanded defi-nition
of the “practice of medicine or surgery.” This new
definition includes advertising or holding out that one is
authorized to practice as a physician and using designa-tions
like “doctor.” Broadly speaking, the use of a des-ignation
like “doctor” by someone not licensed by this
Board is lawful only if the person using the designation
has a doctorate degree, is licensed by another health care
licensing agency, and makes it clear in which branch of the
healing arts he or she is practicing.
Powers and Duties
Section 5 of House Bill 818 includes two major de-velopments.
The bill authorizes the Board to regulate the
disposition and disposal of medical records and to appoint
a custodian for abandoned medical records. This law does
not apply to hospitals and other health care institutions,
only individual Board licensees. Looking to long range
changes, the bill authorizes the Board to develop and im-plement
methods of assessing and improving physician
practice and ensuring ongoing competence of licensees.
This new authority fits in with the national trend regard-ing
continued competence.
Conducting Hearings
The definitions section in House Bill 818 includes the
term “hearing officer,” which is defined as current and
past Board members who are an MD, DO, PA, or NP, as
well as current or retired members of the judiciary. Sec-tion
18 of the bill allows the Board to use these hearing
officers to conduct disciplinary and licensing hearings.
Historically, almost all hearings have been conducted by
sitting Board members. This provision expands the pool
of individuals who can hear Board cases and should per-mit
the Board to conduct more hearings and in a more
timely fashion.
Availability of Information to Complainants
Section 22 of House Bill 818 provides for greater access
to information on the part of patients and certain other
persons who complain to the Board about a licensee. The
new law requires that the Board inform the complainant
of the fact of and the basis for the Board’s disposition
of the complaint. For a number of years, the Board has
informed complainants in a very timely fashion of the dis-position
of their complaints along with providing limited
information about the nature or basis of the resolution
of the complaint. The Board is currently studying how
to strike the ideal balance between greater transparency
to complainants in the disposition of cases not requiring
formal disciplinary action and maintaining the effective-ness
of such actions, which are critical to ensuring safe
medical practice.
In addition, the new law gives the Board the discretion
to supply to the complainant the licensee’s written re-sponse
to a complaint, which was protected as confiden-tial
under the previous law. The Board is in the process
“The bill autho-rizes
the Board
to regulate
the disposition
and disposal of
medical records
and to appoint
a custodian
for abandoned
medical records”
R. David Henderson, ex-ecutive
director of the North
Carolina Medical Board, has
announced that Governor
Easley recently appointed
Thelma C. Lennon, of Ra-leigh,
as a public member of
the Board. She replaces E.K.
Fretwell, PhD, of Charlotte.
Mr Henderson said: “Ms Len-non
is fully committed to the
work of the Board and to the
health and safety of the people
of North Carolina. She brings a wealth of experience and
talent to the Board and we are deeply pleased to welcome
her.”
Ms Lennon earned her bachelor of science degree
from North Carolina Central University. She earned her
master’s degree from Boston University in guidance and
counseling and did further study of the subject at Harvard
University. She also completed graduate study in adult
education at North Carolina State University.
During her professional career, Ms Lennon served in
education as an instructor and dean of students at a num-ber
of academic institutions. Before retiring, she worked
as director of guidance and counseling for the North Caro-lina
Department of Education.
While working, Ms Lennon was actively involved in
the College Entrance Examination Board, National Voca-tional
Guidance Association (of which she was president),
National Career Guidance Association (of which she was
president and chairman of the Commission on Women),
14 NCMB Forum
Ms Lennon
the National Career Guidance Institute of the University
of Southern California (of which she was chairman), and
the Education Trust Advisory Council. To name only a
few of her many community services, she was actively in-volved
with the North Carolina Center for Public Policy
Research, Wake County Health Services, Inc, and Raleigh
Housing Authority.
Since her retirement, Ms Lennon has devoted much of
her time to volunteer activities focusing on health and edu-cation.
She is currently a counselor at the North Carolina
Department of Insurance’s Senior Health Insurance Infor-mation
Program (SHIIP), a member of the Board of Di-rectors
of the Carolinas Center for Medical Excellence, and
chairman for the Alliance for Medical Excellence. She is
also a member of the Wake County Community Advisory
Council for Nursing Homes and the Governor’s Advisory
Council on Aging.
From 1996 to 2000, Ms Lennon served as the first
American Association of Retired Persons (AARP) North
Carolina state president and was selected as an alternate
delegate to the White House Conference on Aging. In
2000, she was recognized by former Governor James
Hunt as one of twelve women to be named “Distinguished
Women of North Carolina.” She has received the Order of
the Long Leaf Pine, the AARP Andrus Award for Com-munity
Service, and most recently, was named Health Care
Hero by the Triangle Business Journal.
She coauthored a journal article on “Counseling the
Culturally Different” in the Ohio State University Educa-tional
Journal, and chaired the committee on the publica-tion
of Navigating the Course of Change in Guidance and
Counseling in Public Schools.
Governor Appoints Thelma C. Lennon, of Raleigh,
to North Carolina Medical Board
of determining under what circumstances it will release
to the complainant the licensee’s written response. The
Board will notify responding licensees of this possibility
and point out that the new law prevents the written re-sponse
provided by the Board from being admitted into
evidence in any civil proceeding against the licensee.
Supervising Laser Hair Practitioners
House Bill 7265 does not make changes to the MPA,
but it permits the NC Board of Electrolysis Examiners to
license laser hair practitioners (LHPs) to use laser devices
to remove or reduce unwanted hair. The licensees of that
board were previously limited to electrolysis. The new law,
in Section 6, requires that LHPs be supervised by a physi-cian
licensed by the Medical Board and that the physician
be on site or readily available. While the statute is silent as
to the need for a history and physical examination for each
patient receiving laser hair removal, this Board has made
clear in its Position Statement and disciplinary actions that
good medical practice requires such an examination prior
to initiating laser hair removal.
Conclusion
The preceding paragraphs do not cover every impor-tant
aspect of the new legislation. There are numerous
other provisions that may be relevant to a licensee of the
Board and of interest to the public. As always, we sug-gest
that licensees consult with their private legal counsel
regarding any questions about whether and how new leg-islation
affects their practice.
__________________________
1Now Session Law 2007-346 and available at www.ncleg.net.
2The Review Panel will not make recommendations regarding the eighth
physician seat that must go to a DO, academic alternative medicine
practitioner or member of the Old North State Medical Society.
3The NCMS will have four members on the Review Panel. The other
organizations represented will have one each.
4Now Session Law 2007-418 and available at www.ncleg.net.
5Now Session Law 2007-489 and available at www.ncleg.net. The effec-tive
date is October 1, 2007. This law does not require that all persons
performing laser hair removal under the supervision of a physician be
licensed by the Electrolysis Examiners.
“The new law, in
Section 6, re-quires
that LHPs
be supervised by a
physician licensed
by the Medical
Board”
No. 3 2007 15
NORTH CAROLINA MEDICAL BOARD
Board Orders/Consent Orders/Other Board Actions
May-June-July 2007
DEFINITIONS:
Annulment:
Retrospective and prospective cancellation of the practitioner’s
authorization to practice.
Conditions:
A term used in this report to indicate restrictions, requirements,
or limitations placed on the practitioner.
Consent Order:
An order of the Board stating an agreement between the Board
and the practitioner regarding the annulment, revocation, sus-pension,
or surrender of the authorization to practice, or the
conditions placed on the authorization to practice, or other ac-tion
taken by the Board relative to the practitioner. (A method
for resolving a dispute without a formal hearing.)
Denial:
Final decision denying an application for practice authoriza-tion
or a request for reconsideration/modification of a previous
Board action.
Dismissal:
Board action dismissing a contested case.
Inactive Medical License:
To be “active,” a medical license must be registered on or near
the physician’s birthday each year. By not registering his or her
license, the physician allows the license to become “inactive.”
The holder of an inactive license may not practice medicine in
North Carolina. Licensees will often elect this status when they
retire or do not intend to practice in the state. (Not related to the
“voluntary surrender” noted below.)
NA:
Information not available or not applicable.
NCPHP:
North Carolina Physicians Health Program.
Public Letter of Concern:
A letter in the public record expressing the Board’s concern
about a practitioner’s behavior or performance. Concern has
not risen to the point of requiring a formal proceeding but
should be known by the public. If the practitioner requests a
formal disciplinary hearing regarding the conduct leading to the
letter of concern, the letter will be vacated and a formal com-plaint
and hearing initiated.
Reentry Agreement:
Arrangement between the Board and a practitioner in good
standing who is “inactive” and has been out of clinical practice
for two years or more. Permits the practitioner to resume active
practice through a reentry program approved by the Board to
assure the practitioner’s competence.
RTL:
Resident Training License. ( Issued to those in post-graduate
medical training who have not yet qualified for a full medical
license.)
Revocation:
Cancellation of the authorization to practice. Authorization
may not be reissued for at least two years.
Stay:
The full or partial stopping or halting of a legal action, such as
a suspension, on certain stipulated grounds.
Summary Suspension:
Immediate withdrawal of the authorization to practice prior to
the initiation of further proceedings, which are to begin within
a reasonable time. (Ordered when the Board finds the public
health, safety, or welfare requires emergency action.)
Suspension:
Withdrawal of the authorization to practice for a stipulated
period of time or indefinitely.
Temporary/Dated License:
License to practice for a specific period of time. Often ac-companied
by conditions contained in a Consent Order.
May be issued as an element of a Board or Consent Order or
subsequent to the expiration of a previously issued temporary
license.
Voluntary Surrender:
The practitioner’s relinquishing of the authorization to practice
pending or during an investigation. Surrender does not pre-clude
the Board bringing charges against the practitioner. (Not
related to the “inactive” medical license noted above.)
For the full text version of each summary and for public documents, please visit the Board’s Web site at www.ncmedboard.org
ANNULMENTS
NONE
REVOCATIONS
EATON, Hubert Arthur, Jr, MD
Location: Wilmington, NC (New Hanover Co) | DOB: 5/25/1943
License #: 0000-17858 | Specialty: IM (as reported by physician)
Medical Ed: Meharry Medical College (1969)
Cause: Dr Eaton has a history of substance abuse. In June 2006, a
urine sample showed Dr Eaton had consumed alcohol in vi-olation
of his March 2005 Consent Order and his NCPHP
contract.
Action: 6/08/2007. Findings of Fact, Conclusions of Law, and Or-der
of Discipline issued following hearing on 4/18/2007:
Dr Eaton’s North Carolina medical license is revoked.
MILLER, Shelly Ann, MD
Location: Raleigh, NC (Wake Co) | DOB: 7/13/1965
License #: 0095-01008 | Specialty: FP (as reported by physician)
Medical Ed: University of Connecticut (1991)
Cause: The NCPHP determined that Dr Miller, who had an
NCPHP contract, was not able to maintain control of her
abuse of mood-altering substances. In May 2006, the
NCPHP recommended she surrender her medical license,
which she did on 6/13//2006. Dr Pendergast testified Dr
Miller did not appear to be clinically stable.
Action: 6/20/2007. Findings of Fact, Conclusions of Law, and Or-der
of Discipline issued following hearing on 6/20/2007 to
consider the recommendation of a hearing panel held on
2/21/2007: Dr Miller’s North Carolina medical license is
revoked.
TROGDON, James Clifford, Nurse Practitioner
Location: Chapel Hill, NC (Orange Co) | DOB: 10/19/1957
Approval #: 0002-01033
NP Education: NA
Cause: The Board received information that during 2005 and
2006, Mr Trogdon forged a physician’s signature on mul-tiple
prescriptions for a controlled substance and gave the
medication to one or more family members. When con-fronted,
he admitted the conduct and surrendered his ap-proval
as an NP on April 5, 2006. He later admitted he had
taken the medications himself.
Action: 6/20/2007. Findings of Fact, Conclusions of Law, and Or-der
of Discipline issued following hearing on 6/20/2007:
Mr Trogdon’s North Carolina NP approval is revoked.
See Consent Orders:
BRYDON, Kim Marie, MD
SUSPENSIONS
HARRIS-CHIN, Cheryl Jacqueline, MD
Location: Charlotte, NC (Mecklenburg Co) | DOB: 3/25/1963
License #: 2002-00914 | Specialty: PD (as reported by physician)
Medical Ed: University of the West Indies (1988)
Cause: The Maryland Board suspended Dr Harris-Chin’s license for
six months in April 2006. It had determined she improperly
accessed medical records, requested a consultation on a ficti-tious
patient, and failed to notify the Board of her change of
address. It also concluded her denial to the Board concern-ing
the issues was unprofessional.
Action: 6/06/2007. Findings of Fact, Conclusions of Law, and Or-der
of Discipline issued following hearing on 4/18/2007:
Dr Harris-Chin’s North Carolina medical license is suspend-ed
for six months.
TERRY, Sandra Louise, Nurse Practitioner
Location: Hope Mills, NC (Sampson Co) : DOB: 3/20/1971
Approval #: 0002-01963
NP Education: NA
Cause: The Nursing Board summarily suspended Ms Terry’s nurs-ing
license in July 2006 based on a history of several convici-tions
for DUI and for eluding arrest in a motor vehicle. On
July 21, 2006, the Nursing Board confirmed its suspension
decision. In April 2007, the Medical Board filed charges
16 NCMB Forum
based on the actions of the Nursing Board.
Action: 7/10/2007. Findings of Fact, Conclusions of Law, and Or-der
of Discipline issued following hearing on 6/20/2007:
Ms Terry’s North Carolina nurse practitioner approval is
suspended indefinitely.
See Consent Orders:
BASAMANIA, Beth P., MD
BLAKE, John Alder, Physician Assistant
CARBONE, Dominick J., Jr, MD
GUARINO, Clinton Toms Andrews, MD
HILL, Monica Rae, DO
HOPE, Shelly-Ann Violet, MD
JOHANSEN, James Richard, MD
MARTIN, Michele I., MD
McKEEL, Cameron Roberts, Physician Assistant
MOCLOCK, Michael Anthony, MD
MORTER, Gregory Alan, MD
NG, Chun-Ho Patrick, MD
STEINER, Drew John, MD
REYNOLDS, Robert Jack, MD
SUMMARY SUSPENSIONS
NONE
CONSENT ORDERS
BASAMANIA, Beth P., MD
Location: Chapel Hill, NC (Orange Co) | DOB: 3/31/1963
License #: 0099-00323 | Specialty: FP (as reported by physician)
Medical Ed: George Washington University (1990)
Cause: Dr Basamania prescribed numerous prescriptions for non-controlled
substances to herself and kept no record of those
prescriptions. She also abused Ultram®. During this time
she did not practice clinical medicine. In June 2006, she
surrendered her medical license.
Action: 7/19/2007. Consent Order executed: Dr Basamania’s
North Carolina medical license is indefinitely suspended.
BENTLEY, Susan Warren, Nurse Practitioner
Location: Huntersville, ND (Mecklenburg Co) | DOB:
7/19/1954
Approval #: 0009-40101
NP Education: NA
Cause: Ms Bentley was asked for a copy of her collaborative prac-tice
agreement with Dr Joseph Jemsek in July 2006. She
provided a document titled “2005 Collaborative Practice
Agreement for Nurse Practitioners at Jemsek Clinic” that in-dicated
it was created in October 2005. The document was
not properly signed or dated by Ms Bentley or Dr Jemsek.
Another nurse practitioner at the clinic indicated no such
agreement was in place in 2004. Earlier documents, called
“protocols” did not comply with the spirit and letter of the
law at that time.
Action: 5/23/2007. Consent Order executed: Ms Bentley is repri-manded.
BLAKE, John Alder, Physician Assistant
Location: Wilmington, NC (New Hanover Co) | DOB: 3/05/1971
License #: 0001-03290
PA Education: The College of West Virginia (2001)
Cause: Mr Blake, operating his own medical practice without a
physician on site to supervise, mismanaged the care of four
patients. Proper consultation with his supervising physician
would most likely have prevented the problems of misman-agement
of his patients. He has no previous disciplinary
history and has taken significant CME. His supervising
physician has developed a remediation plan concerning the
issues in the case and Mr Blake has implemented an elec-tronic
medical records system for all his patients. All but one
of the patients involved continue treatment by Mr Blake.
Action: 6/18/2007. Consent Order executed: Mr Blake’s PA license
is suspended for one year; suspension is stayed and he is
placed on probation on terms and conditions; he shall have
on-site supervision and meet with his primary supervising
physician on a weekly basis for six months; he shall submit
himself to the Center for Personalized Education for Physi-cians
by July 31, 2007, for assessment and provide resulting
reports to the Board; must comply with other requirements
related to the issues of the case.
BRYDON, Kim Marie, MD
Location: Raleigh, NC (Wake Co) | DOB: 11/06/1957
License #: 0000-33795 | Specialty: P (as reported by physician)
Medical Ed: University of Kansas (1987)
Cause: Dr Brydon had a sexual relationship with a patient. When
working for the North Carolina Correctional Institute for
Women, Dr Brydon began treating an inmate for mental
problems in 2001. A year after being released from NC-CIW,
the patient moved in with Dr Brydon and they be-gan
a sexual relationship. The patient was later reincarcer-ated
based on her obtaining prescription drugs by forging
Dr Brydon’s name on prescription blanks from one of Dr
Brydon’s old prescription pads. Dr Brydon saw the patient
again after the patient was readmitted to NCCIW. Dr Bry-don
has admitted this was inappropriate but she did it in
an effort to conceal the relationship they had. Dr Brydon
voluntarily surrendered her license in April 2007.
Action: 6/26/2007. Consent Order executed: Dr Brydon’s North
Carolina medical license is revoked.
CARBONE, Dominick J., Jr, MD
Location: Winston-Salem, NC (Forsyth Co) | DOB: 8/09/1965
License #: 0097-00498 | Specialty: US (as reported by physician)
Medical Ed: University of Michigan Medical School (1990)
Cause: Application for reinstatement of license. From December
2005 to March 2006, Dr Carbone had a consensual sexual
relationship with a patient. He ceased practice in Decem-ber
2006 and surrendered his license in January 2007. His
license was indefinitely suspended in 2007 via Consent Or-der.
He has completed an in-depth evaluation at the Profes-sional
Renewal Center in Kansas and has a contract with the
NCPHP.
Action: 7/01/2007. Consent Order executed: Dr Carbone is is-sued
a license; that license is suspended and suspension is
stayed on probationary terms; he shall maintain and abide
by a contract with the NCPHP; must comply with other
conditions.
COLLINS, Paul Dwayne, MD
Location: Pembroke, NC (Robeson Co) | DOB: 2/08/1973
License #: 2005-00139 | Specialty: FP (as reported by physician)
Medical Ed: Wake Forest University School of Medicine (2001)
Cause: On application to reinstate license. Because of his history
of alcohol and substance abuse, Dr Collins entered a Con-sent
Order with the Board in 2005 to obtain a license. In
February 2006, he tested positive for alcohol, violating his
Consent Order and his contract with the NCPHP. He sur-rendered
his license in March. Since July 2006, he has un-dergone
weekly therapy and attends AA. He reports he has
abstained from alcohol and mind-altering substances since
that time. He has a five-year contract with the NCPHP and
the NCPHP reports he is in compliance.
Action: 5/25/2007. Consent Order executed: Dr Collins is is-sued
a license to expire on the date shown on the license
[6/30/2007]; he shall be on probation for 12 months; he
shall maintain and abide by a contract with the NCPHP; he
shall attend AA and/or NA meetings weekly; he shall work
no more than 40 hours per week and shall not take call,
he shall abide by all recommendations of his treatment pro-gram
and therapist; unless lawfully prescribed by another
person, he shall refrain from use of all mind- or mood-alter-ing
substances and alcohol; he shall submit to drug/alcohol
No. 3 2007 17
screenings as requested by the Board; must comply with
other conditions.
COOPER, Armah Jamale, MD
Location: Butner, NC (Granville Co) | DOB: 5/28/1956
License #: 0000-29096 | Specialty: P/FRY (as reported by physician)
Medical Ed: Meharry Medical College (1981)
Cause: Dr Cooper has, on occasion, prescribed for himself for his
epilepsy when prescriptions from his physician in Maryland
were delayed. To do this, he wrote prescriptions in the name
of a friend, taking the drug himself. He has been evaluated
by the NCPHP and does not appear to have an abuse prob-lem.
He has also enrolled in a prescribing course and has
been referred to appropriate physicians for his care.
Action: 7/09/2007. Consent Order executed: Dr Cooper is repri-manded.
COULSON, Alan Stewart, MD
Location: Hamlet, NC (Richmond Co) | DOB: 6/21/1941
License #: 2000-01476 | Specialty: VS (as reported by physician)
Medical Ed: Guy’s Hospital Medical School, UK (1970)
Cause: Dr Coulson’s cardiac surgical privileges were suspended at
his hospital. Review of the charts of four of his patients
for the Board by an outside expert noted Dr Coulson failed
to meet acceptable standards in three of the cases. Review
of the charts of five vascular surgical patients by an outside
expert indicated appropriate care.
Action: 6/20/2007. Consent Order executed: Dr Coulson’s license
is limited: he shall not perform cardiac surgery in North
Carolina; he agrees to periodic chart review; must comply
with other conditions.
DASSO, Edwin Joseph, MD
Location: Greensboro, NC (Guilford Co) | DOB: 6/26/1955
License #: 2007-01165 | Specialty: AN (as reported by physician)
Medical Ed: University of Texas Southwestern Med Center, Dallas
(1983)
Cause: Dr Dasso holds licenses in several states and has not prac-ticed
clinical medicine since 1994. He works as a medical
director for insurance companies. He has no plans to prac-tice
clinical medicine in North Carolina.
Action: 7/11/2007. Consent Order executed: Dr Dasso is issued
a limited administrative license that requires he not practice
clinical medicine; should he decide to resume clinical prac-tice,
the Board president must approve a plan for updating
his skills and his practice site.
DAVIDSON, Arthur Turner, Jr, MD
Location: New York, NY | DOB: 8/30/1947
License #: 2007-00917 | Specialty: NA
Medical Ed: Howard College of Medicine (1975)
Cause: Dr Davidson signed a Consent Order with the New York
Board accepting a censure and reprimand, agreeing to take a
targeted CME course, and agreeing to a two-year probation
as a result of prescribing for his wife during her pregnancy.
He has completed the terms of his agreement with New
York and holds a medical license there. This North Caro-lina
Consent Order is intended only to make Dr Davidson’s
New York record a matter of public record in North Caro-lina.
Action: 6/05/2007. Non-Disciplinary Consent Order executed: Dr
Davidson is issued a North Carolina medical license.
DAUITO, Ralph, MD
Location: Vineland, NJ | DOB: 3/31/1956
License #: 2007-01012 | Specialty: R (as reported by physician)
Medical Ed: Georgetown University School of Medicine (1984)
Cause: On appeal of a license denial. Dr Dauito signed a Consent
Order with the New Jersey Board in December 2001 admit-ting
to certain findings regarding his treatment of a patient.
He failed to diagnose a pseudoaneurysm because he did
not view all of the X-rays. Later, he made the diagnosis but
failed to inform the patients physician. He was reprimand-ed
and required to take ethics course and an angiography
course, and pay a fine. His license was suspended with a stay
based on his compliance with conditions placed on him. He
agrees to abide by the conditions set in New Jersey in North
Carolina. A North Carolina license is granted on conditions
set forth in the following Consent Order.
Action: 6/18/2007. Consent Order executed: Dr Dauito is repri-manded
as a reciprocal action to the New Jersey reprimand;
he shall have an audit of his practice to determine the hours
he works, the number of patients he sees per week, and the
types of radiology he performs; the North Carolina Board
president will review the audit results to determine if any
limits should be put on Dr Dauito’s practice; he must com-ply
with other conditions.
GREER, Gary Wayne, MD
Location: Hickory, NC (Catawba Co) | DOB: 9/17/1953
License #: 0096-01621 | Specialty: EM (as reported by physician)
Medical Ed: Harvard Medical School (1979)
Cause: Dr Greer wrote prescriptions for himself and a patient with
whom he had a close family relationship. He made no
medical record in either case. It does not appear that the
drugs prescribed were inappropriate for his or his relative’s
medical conditions. He was not aware of the restrictions on
such prescribing and has placed himself under the care of a
personal physician. The relative has also been placed under
the care of a personal physician. Dr Greer has practiced for
27 years without any other Board action against him. He
will take remedial training related to the prescribing issue.
Action: 6/20/2007. Consent Order executed: Dr Greer’s license
is cited with a Public Letter of Concern; he shall comply
with the relevant Board position statements and shall attend
a prescribing course within 12 months; must comply with
other conditions.
GUARINO, Clinton Toms Andrews, MD
Location: Hickory, NC (Catawba Co) | DOB: 2/04/1966
License #: 0099-00062 | Specialty: IM (as reported by physician)
Medical Ed: Wake Forest University School of Medicine (1996)
Cause: In 2005, Dr Guarino voluntarily surrendered his North
Carolina medical license as a result of his arrest for traffic
offenses and evidence that he suffered a substance abuse/de-pendency
condition. In January 2006, he entered into a
Consent Order with the Board suspending his medical li-cense.
In September 2006, he pled guilty to DUI, driving
on a restricted license, and felony eluding arrest stemming
from the 2005 incident. In October 2006, he entered a sec-ond
Consent Order with the Board reinstating his license on
a temporary basis with conditions related to his situation.
In November, Dr Guarino tested positive for drug use on
screenings by the Board and the NCPHP. On December 7,
2006, he surrendered his license.
Action: 6/18/2007. Consent Order executed: Dr Guarino’s North
Carolina medical license is indefinitely suspended; he may
not apply for reinstatement for at least one year.
HARRELL, Raymond Martin, MD
Location: Chapel Hill, NC (Orange Co) | DOB: 7/13/1975
License #: RTL | Specialty: AN (as reported by physician)
Medical Ed: University of North Carolina School of Medicine (2007)
Cause: Dr Harrell has a history of substance and alcohol abuse. He
sought help at an inpatient facility and has been sober since
2000. He has a monitoring contract with the NCPHP.
Action: 6/21/2007. Consent Order executed: Dr Harrell is is-sued
a resident training license for UNC Hospital; he shall
maintain and abide by a contract with the NCPHP; he shall
meet with the Board as requested and shall provide a letter
from his program director evaluating his performance; he
shall submit to drug/alcohol screenings as requested by the
Board; unless lawfully prescribed by another person, he shall
refrain from the use or possession of all mind- or mood-altering
substances and controlled substances; must comply
with other conditions.
18 NCMB Forum
HILL, Monica Rae, DO
Location: Lumberton, NC (Robeson Co) | DOB: 1/18/1968
License #: 2003-00805 | Specialty: IM (as reported by physician)
Medical Ed: Des Moines University Osteopathic Medical Center (1998)
Cause: Dr Hill attempted to gain payment for acquired time off for
a friend and former co-worker who had been fired for cause
by the hospital in which Dr Hill worked as a hospitalist. The
hospital did not offer such payments in those situations. She
called the vice president and COO of the hospital, asked the
payment be made as a favor to her, and offered to provide
an expert review that would make the hospital look good if
payment were made. In fact, she had no case in which she
was providing an expert review. She was, in essence, bluff-ing
to assist her former co-worker.
Action: 6/20/2007. Consent Order executed: Dr Hill’s North Car-olina
medical license is suspended for 30 days; suspension is
stayed; she shall obey all laws and regulations related to the
practice of medicine.
HOPE, Shelly-Ann Violet, MD
Location: Lenoir, NC (Caldwell Co) | DOB: 9/23/1963
License #: 2003-00157 | Specialty: OB/GYN (as reported by physi-cian)
Medical Ed: Howard University (1990)
Cause: Dr Hope issued prescriptions to patients without first per-forming
a physical examination. From May to September
2006, she provided medical services for one John Garcia
through Inetmedic.com, a business that renders medical
services via the Internet. He told her as long as she was
licensed in North Carolina she need not be licensed else-where.
She issued numerous prescriptions without physical
examinations and allowed Inetmedic to bill patients for her
services. She was paid $25 per patient. From October 2006
to March 2007, she contracted with Juan Ibanez, MD, to
provide medical services through online companies owned
by him. Again, she authorized numerous prescriptions
without examining patients. She allowed Ibanez to bill pa-tients
for her services and she was paid $5,000 per month.
She admits that she was assisting in the unlicensed practice
of medicine in North Carolina by Ibanez and his group, and
by Garcia and his group.
Action: 6/20/2007. Consent Order executed: Dr Hope’s North
Carolina medical license is suspended for 90 days; suspen-sion
is stayed on probationary terms and conditions; she
shall comply with the Board’s position statements on pre-scribing
and within 12 months she shall take and complete
a course on prescribing; she shall not prescribe without per-forming
a physical examination and she shall not assist any
person or entity in the unlicensed practice of medicine in
North Carolina; must comply with other conditions.
HUMBLE, Scott David, MD
Location: Raleigh, NC (Wake Co) | DOB: 9/28/1970
License #: 2007-00897 | Specialty: PTH (as reported by physician)
Medical Ed: Wake Forest University School of Medicine (1998)
Cause: Dr Humble recognized he was abusing alcohol during
postgraduate training in Florida and voluntarily entered the
Florida Professionals Resource Network with a five-year
monitoring contract. In October 2006, he entered a con-tract
with the NCPHP, which did not express reservations
about his ability to practice safely.
Action: 5/30/2007. Consent Order executed: Dr Humble is issued
a medical license [to expire 11/30/2007]; he shall maintain
and abide by his NCPHP contract; he shall submit to drug/
alcohol screenings as requested by the Board; unless lawfully
prescribed by another person, he shall refrain from the use
or possession of all mind- or mood-altering substances and
controlled substances, including alcohol; must comply with
other conditions.
JOHANSEN, James Richard, MD
Location: Shelby, NC (Cleveland Co) | DOB: 9/12/1959
License #: 0096-00957 | Specialty: FP (as reported by physician)
Medical Ed: University of California, Irvine (1986)
Cause: In February 2007, Dr Johansen abruptly and without notice
to patients closed his practice. He told his staff to stay at the
practice for several days so they could inform patients with
appointments that the practice was closed. He informed the
Board that a domestic situation had caused him to close his
practice and asked guidance. He did not mail notices to pa-tients
nor provide his patients information on how to obtain
their records. A Board investigator visited the office loca-tion
and found no contact information or instructions for
patients, though there were 10 notes from patients stuck in
the door asking for their records. Complaints were received
by the Board as late as March 16, 2007, about being unable
to obtain records. The Board contacted Dr Johansen and
told him to facilitate informing all patients about obtain-ing
records. He reports he did as requested. Investigation
found this to be true. Dr Johansen has kept the Board in-formed
of his efforts to meet his ethical responsibilities since
that time. A new group has taken over the practice and it
has reopened.
Action: 6/20/2007. Consent Order executed: Dr Johansen’s North
Carolina medical license is suspended for two years as of
5/01/2007; suspension will be stayed as of 6/15/2007 and
he is placed on probation on terms and conditions; he shall
obey all laws and regulations related to medical practice and
comply with all ethical responsibilities regarding closing of
his practice; must comply with other conditions.
JONES, Robert Glen, MD
Location: Raleigh, NC (Wake Co) | DOB: 4/06/1959
License #: 0094-00536 | Specialty: OSM/SM (as reported by physi-cian)
Medical Ed: Emory University School of Medicine (1988)
Cause: On application for license reinstatement. Dr Jones surren-dered
his license in June 2006 and his license was suspended
by consent order in September 2006 as a result of his alcohol
abuse. The NCPHP reported he has been in compliance
with his NCPHP contract and there is no evidence patient
care was compromised by his use of alcohol.
Action: 7/26/2007. Consent Order executed: Dr Jones’ is issued
a temporary/dated license to expire on the date shown on
the license [11/30/2007]; he shall maintain and abide by
a contract with the NCPHP; unless lawfully prescribed by
someone else, he shall not use mind- or mood-altering sub-stances,
controlled substances, or alcohol and shall notify
the Board if and when such are prescribed; he shall supply
hair and/or bodily fluids for screening as requested by the
Board; he shall attend AA or Caduceus meetings; must
comply with other conditions.
MARTIN, Michele I., MD
Location: Statesville, NC (Iredell Co) | DOB: 5/20/1965
License #: 0096-01667 | Specialty: GP/P (as reported by physician)
Medical Ed: Loma Linda University (1994)
Cause: Between April 2003 and July 2006, Dr Martin had an inti-mate
relationship with Patient A but did not end their exist-ing
patient-physician relationship. She continued to give
treatment, including prescribing controlled medications, to
Patient A. From early 1999 to early 2002, she also wrote
prescriptions for Patient B, a family member.
Action: 6/19/2007. Consent Order executed: Dr Martin’s North
Carolina medical license is suspended for six months; sus-pension
is stayed on probationary terms; she shall attend the
Vanderbilt courses on prescribing controlled substances and
on maintaining proper boundaries within 12 months; she
shall maintain and abide by a contract with the NCPHP; she
shall perform 100 hours of community service approved by
the Board president; must comply with other conditions.
McKEEL, Cameron Roberts, Physician Assistant
Location: Asheville, NC (Buncombe Co) | DOB: 1/09/1968
No. 3 2007 19
License #: 0001-03586
PA Education: NA
Cause: Mr McKeel has a significant criminal history with previous
convictions for DUI, possession of drug paraphernalia, and
breaking and/or entering. In October 2006, he was arrested
in South Carolina and charged with illegal possession of
prescription medication, which he later admitted to Board
investigators. He also admitted possession of marijuana
and chronic alcohol use. A urine sample in December 2006
was positive for amphetamine, marijuana, and alcohol. In
October 2006, Mr McKeel was also arrested in Buncombe
County for felony assault by strangulation and misdemeanor
assault on a female. He later admitted to Board investiga-tors
that he did touch the alleged female victim’s neck and
head.
Action: 5/30/2007. Consent Order executed: Mr McKeel’s PA li-cense
is suspended indefinitely.
MOCLOCK, Michael Anthony, MD
Location: Dubois, PA | DOB: 11/18/1951
License #: 2007-01013 | Specialty: FP (as reported by physician)
Medical Ed: Medical College of Pennsylvania (1990)
Cause: On application for a North Carolina license. Dr Moclock
entered into a Consent Agreement with the Pennsylvania
Board in 2006 in which he admitted he abused alcohol and
suffered active alcohol dependency from 1999 to 2001 and
self-prescribed cough syrup with hydrocodone in 2001. He
voluntarily sought treatment in 2004 and later in 2004 re-lapsed.
He is now participating in the PHMP monitoring
program. In 2006, he was assessed by the NCPHP, which
has no reservations about his ability to practice safely.
Action: 6/14/2007. Consent Order executed: Dr Moclock is issued
a North Carolina medical license; his license is suspended
indefinitely, suspension is stayed on terms and conditions, he
is placed on probation for three years; he shall abide by the
terms of the Pennsylvania Consent Order and shall enter a
five-year contract with the NCPHP and abide by its terms;
he shall submit to drug/alcohol screenings as requested by
the Board; unless lawfully prescribed by another person,
he shall refrain from the use of all mind- or mood-altering
substances, controlled substances, and alcohol; must comply
with other conditions, must comply with other conditions.
MORTER, Gregory Alan, MD
Location: Wilmington, NC (New Hanover Co) | DOB: 12/03/1959
License #: 0000-36401 | Specialty: PD (as reported by physician)
Medical Ed: University of Pittsburgh (1986)
Cause: Dr Morter has a history of substance abuse. In 2005, he
entered a Consent Order with the Board requiring he report
to the Board and the NCPHP any prescription he might re-ceive
for mind- or mood-altering substances, but he did not
notify the Board or the NCPHP when a hydrocodone-con-taining
cough syrup was prescribed by his physician. He did
not disclose his use of this prescription when asked about
drug use recently and when a routine drug screen was done.
In February 2007, he admitted to a Board investigator that
he abused hydrocodone after a difficult court date involving
a domestic situation. He surrendered his medical license in
April 2007.
Action: 7/17/2007. Consent Order executed: Dr Morter’s North
Carolina medical license is suspended indefinitely.
NG, Chun-Ho Patrick, MD
Location: Kannapolis, NC (Cabarrus Co) | DOB: 4/06/1959
License #: 0000-32813 | Specialty: FP (as reported by physician)
Medical Ed: Medical College of Georgia (1985)
Cause: Expert review of five patient charts revealed Dr Ng’s docu-mentation
of care and ongoing treatment and management
of medications was below the standard of care. The expert
indicated this failing was in part a symptom of Dr Ng’s reli-ance
on electronic recordkeeping. The expert also concluded
Dr Ng’s failure to use pain contracts in treatment of chronic
pain patients was below the standard of care. Kannapolis
police charged him with unlawfully dispensing a controlled
substance without finding a medical reason. The Board
summarily suspended his medical license on 2/22/2007.
Many of his colleagues have written the Board attesting to
his competence and professionalism.
Action: 7/20/2007. Consent Order executed: Dr Ng’s medical
license is suspended for five months, running retroactively
from 2/22/2007; at the end of the five months, he may re-turn
to practice under probationary terms related to record-keeping
and proper prescribing; must comply with other
conditions.
PUSEY, Tanya Terese, Nurse Practitioner
Location: Huntersville, NC (Mecklenburg Co) | DOB:
4/27/1970
Approval #: 0002-01713
NP Education: Clemson University (2002)
Cause: Ms Pusey worked for Dr Joseph Jemsek between 2003 and
2005. The Board asked her for a copy of her collaborative
practice agreement with Dr Jemsek in July 2006. She pro-vided
what she termed a protocol agreement because col-laborative
agreements were not in place at the time of her
employment. The “protocol” was not properly signed or
dated by Ms Pusey or Dr Jemsek and did not comply with
the spirit and letter of the law at that time.
Action: 5/21/2007. Consent Order executed: Ms Pusey is repri-manded.
REYNOLDS, Robert Jack, MD
Location: Knoxville, TN | DOB: 12/09/1953
License #: 0000-27968 | Specialty: AM/IM (as reported by physi-cian)
Medical Ed: University of Tennessee (1980)
Cause: In April 2005, Dr Reynolds pled guilty to DUI in Colorado
and the next year he pled guilty to DUI in Buncombe Coun-ty,
NC. Following these convictions, he entered a contract
with the NCPHP. In March 2006, Dr Reynolds tested posi-tive
for alcohol, having failed to call the NCPHP to check
on the need for urine screens earlier as required. He says his
failure to call the NCPHP was an oversight. Dr Reynolds
has not practiced clinical medicine since 2000. He admits
that when abusing alcohol he is unable to practice appropri-ately.
Action: 6/05/2007. Consent Order executed: Dr Reynolds’ North
Carolina medical license is suspended for four months; sus-pension
is stayed on terms and conditions; he shall maintain
and abide by his NCPHP contract; he shall submit to drug/
alcohol screenings as requested by the Board; he shall pro-vide
a copy of this Consent Order to all current and prospec-tive
employers; unless lawfully prescribed by another person,
he shall refrain from the use or possession of all mind- or
mood-altering substances and controlled substances; must
comply with other conditions.
ROESKE, Christie Furr, Nurse Practitioner
Location: Belmont, NC (Gaston Co) | DOB: 9/28/1971
Approval #: 0002-01176
NA Education: NA
Cause Ms Roeske was employed by the Jemsek Clinic and was su-pervised
by Dr Joseph G. Jemsek from 2002 to 2007. In
July 2006, she was asked to provide the Board a copy of
her Collaborative Practice Agreement with Dr Jemsek. She
provided a document that noted it was created in October
2005. It was neither signed nor dated. Another nurse prac-titioner
at the clinic indicated no such document existed in
2004 when she began work. The Board found that docu-ments
that did exist did not meet the requirements of the
rules and regulations.
Action: 5/23/2007. Consent Order executed: Ms Roeske is repri-manded.
SKELTON, Henry Grady, III, MD
20 NCMB Forum
Location: Tucker, GA | DOB: 6/09/1951
License #: 2004-00265 | Specialty: PTH/DMPD (as reported by phy-sician)
Medical Ed: Medical College of Georgia (1979)
Cause: In September 2006, the Georgia Board reinstated Dr Skel-ton’s
Georgia license, issuing a fine and a reprimand as a
result of his practicing without a valid license because he
failed to renew his license on the appropriate date.
Action: 5/17/2007. Consent Order executed: Dr Skelton is repri-manded.
SMILEY, Margaret Lynn, MD
Location: Durham, NC (Durham Co) | DOB: 7/11/1952
License #: 0000-28347 | Specialty: ID/IM (as reported by physician)
Medical Ed: Duke University School of Medicine (1978)
Cause: Dr Smiley has not practiced clinical medicine since 1988
and her position with a pharmaceutical company does not
involve clinical practice. She has had an inactive license and
now applies for a limited administrative license.
Action: 7/13/2007. Non-Disciplinary Consent Order executed: Dr
Smiley is granted a limited administrative license that re-quires
she not practice clinical medicine in North Carolina.
SMITH, Kathleen Jeanne, MD
Location: Tucker, GA | DOB: 3/06/1951
License #: 2004-00601 | Specialty: D/DMP (as reported by physi-cian)
Medical Ed: University of Iowa College of Medicine (1975)
Cause: Dr Smith’s Georgia license was reinstated in 2006 via a
Consent Order. She was fined and reprimanded for practic-ing
without a license because she failed to renew her license
on the appropriate date.
Action: 5/22/2007. Consent Order executed: Dr Smith is repri-manded.
STEINER, Drew John, MD
Location: Elkin, NC (Surry Co) | DOB: 12/03/1962
License #: 0099-01479 | Specialty: FP/EM (as reported by physician)
Medical Ed: Georgetown University (1989)
Cause: Dr Steiner has an alcohol abuse problem. He surrendered
his medical license in January 2007 and entered an inpatient
treatment program, which he completed successfully in May
2007. He has a five-year contract with the NCPHP. There
is no evidence his care of patients was ever compromised by
his use of alcohol.
Action: 7/30/2007. Consent Order executed: Dr Steiner’s medi-cal
license is indefinitely suspended as of 1/10/ 2007; must
comply with certain conditions.
WALDMAN, Richard Alan, MD
Location: Whiteville, NC (Columbus Co) | DOB: 4/07/1942
License #: 0000-39134 | Specialty: PD (as reported by physician)
Medical Ed: New York University (1968)
Cause: A review of the medical records of seven of Dr Waldman’s
patients showed he failed to maintain coherent and accurate
records. He also failed to meet the Board’s CME require-ment
for the three-year period 2002-2004.
Action: 6/05/2007. Consent Order executed: Dr Waldman is rep-rimanded;
he shall comply with the Board’s Position State-ment
on Medical Record Documentation; he shall attend
and satisfactorily complete an intensive course on record
keeping; he shall complete 20 hours of Category I CME
within one year; must comply with other requirements.
WEED, Barry Christopher, MD
Location: Raleigh, NC (Wake Co) | DOB: 7/06/1969
License #: 2002-00625 | Specialty: P (as reported by physician)
Medical Ed: East Carolina University School of Medicine (1998)
Cause: Dr Weed has a history of alcohol and substance abuse. As a
result, he entered a contract with the NCPHP after gradu-ation
from medical school. Although the Board received
favorable reports from the NCPHP regarding Dr Weed,
he began to think he could drink safely in moderation. In
2005, he had a single-vehicle accident and was charged with
DUI. He disclosed this incident to the Board, but a crimi-nal
record check revealed certain misdemeanor convictions
he did not disclose on his application for a license in 2002.
He believed those incidents, happening when he was a teen-ager,
did not have to be noted. In June 2006, he entered
inpatient treatment for his substance abuse, which he suc-cessfully
completed. He voluntarily surrendered his North
Carolina medical license in November 2006. He has now
applied for reinstatement.
Action: 6/08/2007. Consent Order executed: Dr Weed’s license is
reinstated subject to conditions and said license will expire
on the date shown on the license [12/08/2007]; he shall
maintain and abide by his NCPHP contract; he shall sub-mit
to drug/alcohol screenings as requested by the Board;
he shall provide a copy of this Consent Order to all current
and prospective employers; unless lawfully prescribed by an-other
person, he shall refrain from the use or possession of
all mind- or mood-altering substances and controlled sub-stances;
must comply with other conditions.
WILLIAMS, Jason Anthony, Physician Assistant
Location: Wake Forest, NC (Wake Co) | DOB: 3/11/1974
License #: 0001-02539
PA Education: Methodist College (1998)
Cause: The Board found Mr Williams had prescribed controlled
substances to a patient his supervising physician had dis-charged
and to another his supervising physician had direct-ed
was to get no narcotics. It also found he did not, on one
occasion, have a statement of supervisory arrangement and,
on one occasion, practiced before submitting his Notice of
Intent to Practice. He promptly corrected the deficiencies in
his compliance when these were called to his attention.
Action: 5/18/2007. Consent Order executed: Mr Williams is repri-manded.
YOUNG, Jordon Terrell, MD
Location: Winterville, NC (Pitt Co) | DOB: 3/06/1972
License #: 2007-01009 | Specialty: IM (as reported by physician)
Medical Ed: Medical University of the Americas, Nevis, West Indies
(2003)
Cause: On application for a license. Dr Young has a history of alco-hol
and drug use. He did not include convictions for pos-session
of controlled substances and probation violation on
his application because he believed it was not necessary since
he received a pardon for the offenses from the Governor of
Florida. He is under contract with the NCPHP and has un-dergone
residential inpatient treatment. He is in compliance
with his NCPHP contract.
Action: 6/15/2007. Consent Order executed: Dr Young is is-sued
a license to expire on the date shown on the license
[12/15/2007]; he is reprimanded; he shall maintain and
abide by his NCPHP contract; he shall submit to drug/al-cohol
screenings as requested by the Board; unless lawfully
prescribed by another person, he shall refrain from the use
of all mind- or mood-altering substances , controlled sub-stances,
and alcohol; the Board endorses issuance of DEA
prescribing privileges to him; he must comply with other
conditions.
MISCELLANEOUS ACTIONS
NONE
DENIALS OF RECONSIDERATION/MODIFICATION
NONE
DENIALS OF LICENSE/APPROVAL
BOWMAN, James Thomas, MD
Location: North Wilkesboro, NC (Wilkes Co) | DOB: 11/16/1951
License #: 0000-21742 | Specialty: FP (as reported by physician)
Medical Ed: Bowman Gray School of Medicine (1977)
No. 3 2007 21
Cause: Dr Bowman’s application is denied on the basis of his past
history with the Board, his criminal history, and his proba-tion
violation in 2003.
Action: 6/04/2007. Letter issued denying Dr Bowman’s applica-tion
for reinstatement of his North Carolina medical license.
[Hearing is scheduled on this action for 8/15/2007.]
VINCENT, Robert Allen, MD
Location: Fitchburg, WI | DOB: 5/15/1944
License #: NA | Specialty: R (as reported by physician)
Medical Ed: University of Wisconsin Medical School (1970)
Cause: An appeal of the Board’s earlier decision to deny a license
to Dr Vincent. The Board found the Boards of California,
North Dakota, and Wisconsin had all taken action against
Dr Vincent’s license.
Action: 6/07/2007. Findings of Fact, Conclusions of Law, and Or-der
of Discipline issued following hearing on 4/18/2007:
Denial of Dr Vincent’s application for a North Carolina
medical license was proper and shall remain in effect.
SURRENDERS
AUGUSTINE, Santhosh, MD
Location: Lumberton, NC (Robeston Co) | DOB: 5/30/1960
License #: 0096-00445 | Specialty: NA
Medical Ed: Trivandrum Medical College, India (1985)
Action: 7/24/2007. Voluntary surrender of North Carolina medical
license.
BLISS, Laura Katherine, MD
Location: Mebane, NC (Alamance Co) | DOB: 4/25/1958
License #: 0095-00018 | Specialty: FP (as reported by physician)
Medical Ed: University of North Carolina School of Medicine (1989)
Action: 6/01/2007. Voluntary surrender of North Carolina medical
license.
COLLINS, Paul Dwayne, MD
Location: Pembroke, NC (Robeson Co) | DOB: 2/08/1973
License #: 2005-00139 | Specialty: FP (as reported by physician)
Medical Ed: Wake Forest University School of Medicine (2001)
Action: 7/13/2007. Voluntary surrender of North Carolina medical
license.
McGHEE, James Ernest, MD
Location: Charlotte, NC (Mecklenburg Co) | DOB: 4/25/1953
License #: 0094-00578 | Specialty: FP (as reported by physician)
Medical Ed: Emory University (1988)
Action: 7/23/2007. Voluntary surrender of North Carolina medical
license.
O’DELL, Kevin Bruce, MD
Location: Shelby, NC (Cleveland Co) | DOB: 6/04/1957
License #: 0000-39312 | Specialty: EM (as reported by physician)
Medical Ed: University of Nebraska (1983)
Action: 7/25/2007. Voluntary surrender of North Carolina medical
license.
PYKE, George Albert, MD
Location: Anna Maria, FL | DOB: 9/24/1948
License #: 0096-00690 | Specialty: FP (as reported by physician)
Medical Ed: University of Miami (1975)
Action: 5/09/2007. Voluntary surrender of North Carolina medical
license.
RAPPAPORT, Richard Alan, Physician Assistant
Location: Marion, NC (McDowell Co) | DOB: 4/30/1974
License #: 0001-03970
PA Education: Emory University PA Program (2003)
Action: 5/22/2007. Voluntary surrender of North Carolina PA li-cense.
RATHBURN, Stephen Don, MD
Location: Asheville, NC (Buncombe Co) | DOB: 7/26/1958
License #: 2002-01516 | Specialty: AN (as reported by physician)
Medical Ed: Northeastern Ohio University (1982)
Action: 4/10/2007. Voluntary surrender of North Carolina medical
license.
PUBLIC LETTERS OF CONCERN
BOOKER, James Judson, IV, MD
Location: Forest, VA | DOB: 11/11/1970
License #: 2002-00089 | Specialty: OB/GYN (as reported by physi-cian)
Medical Ed: Medical College of Virginia (1998)
Cause: A Letter of Concern was issued by the Florida Board regard-ing
Dr Booker. He was also fined and required to attend
CME courses in risk management and to perform commu-nity
service. The North Carolina Board is concerned that
Dr Booker left a foreign body in a patient during a surgical
procedure.
Action: 5/09/2007. Public Letter of Concern issued: Dr Booker
is admonished and cautioned that a repetition of such an
incident may lead to disciplinary proceedings.
CABBELL, Kyle Lawrence, MD
Location: Greensboro, NC (Guilford Co) | DOB: 11/05/1964
License #: 0098-00482 | Specialty: NS (as reported by physician)
Medical Ed: Stanford University (1986)
Cause: The Board is concerned that Dr Cabbell performed an ante-rior
cervical diskectomy, arthrodesis and anterior instrumen-tation
at the wrong point.
Action: 6/14/2007. Public Letter of Concern issued: Dr Cabbell is
informed of the Board’s concern about issues of quality of
care and cautions him that a repetition of such an incident
may lead to disciplinary proceedings.
ENNEVER, Peter Robert, MD
Location: Greensboro, NC (Guilford Co) | DOB: 5/19/1960
License #: 0095-00567 | Specialty: HO/IM (as reported by physi-cian)
Medical Ed: George Washington University (1988)
Cause: The Board is concerned that Dr Ennever treated and pre-scribed
Oxycodone to a co-worker, a person with whom he
had a significant emotional relationship.
Action: 5/21/2007. Public Letter of Concern issued: Dr Ennever
is admonished and cautioned that a repetition of such an
incident may lead to disciplinary proceedings.
GOUDARZI, Kamran, MD
Location: Wilmington, NC (New Hanover Co) | DOB:
11/29/1953
License #: 0000-25503 | Specialty: GS/VA (as reported by physician)
Medical Ed: University of London (1978)
Cause: The Board has been notified of a payment made on Dr
Goudarzi’s behalf in resolution of a claim rising out of a sur-gery
in which he removed a patient’s second rib rather than
the intended first rib. The Board recognizes this is a known
risk of such surgery but is concerned treatment of the patient
may have fallen below the standard of care.
Action: 6/14/2007. Public Letter of Concern issued: Dr Goudarzi
is cautioned that a repetition of such an incident may lead to
disciplinary proceedings.
HINDS, David McDonald, Physician Assistant
Location: Goldsboro, NC (Wayne Co) | DOB: 3/05/1947
License #: 0001-00200
PA Education: University of North Carolina (1977)
Cause: Mr Hinds practice three years under supervision of Dr
Charles Land without first filing an intent to practice form
with the Board.
Action: 7/10/2007. Public Letter of Concern issued: The Board is
concerned about such an extended violation of regulations
and cautions Mr Hin

Like the legendary Gordian
knot, the issue of physician in-volvement
in judicial executions
is an entanglement of admin-istrative
agencies, the courts,
the legislature, and conflicting
public policies within our state.
For its part, the Board has at-tempted
to solve this dilemma
by harmonizing the ethics of the
medical profession, the Board’s
disciplinary authority, and the
statutory requirements for execu-tions.
Those considerations can
be summarized as follows.
• Two thousand years of medical principles and the AMA
Code of Ethics state that physician participation in execu-tions
is unethical.
• North Carolina law authorizes the Board to discipline doc-tors
for unethical behavior.
• The warden of Central Prison is required to have a physi-cian
present during executions.
Since the issue has been in the news occasionally in the past
year, I thought some of you might be interested in learning
how we arrived at the doorstep of this conundrum.
In This Issue of the FORUM
forum N C M E D I C A L B O A R D
Primum Non Nocere No. 3, 2007
Item Page Item Page
President’s Message
Primum Non Nocere
NORTH CAROLINA
MEDICAL BOARD
April 15, 1859
H. Arthur McCulloch, MD
Physician Participation in Executions:
The Gordian Knot of the Medico-Legal Arena
In April 2006, the Board received a complaint alleging
that a physician was scheduled to participate in an execution.
Upon investigation, it was determined, based on representa-tions
by the Department of Correction, that no physician had
previously participated in an execution, nor was there any plan
for physician participation in upcoming executions. Shortly
following that complaint, the Board received several inqui-ries
from physicians licensed by the Board, asking about the
Board’s position on physician involvement in executions.
Realizing that the issue of physician involvement in execu-tions
would recur, the Board decided it was appropriate to
consider a Position Statement addressing the ethics and dis-ciplinary
consequences of such physician involvement. After
deliberation by the Board, a public hearing, and the publish-ing
of a draft statement in the Forum, a Position Statement
was adopted this past January.*
Since we had been assured by authorities that the physician
of the penitentiary was merely present and had no active role,
the Board’s Position Statement sought to enforce the ethics
of the profession up to the point that the legislature limited
our authority. Thus, we clarified our recognition of state law
and the requirement for the presence of a physician but gave
notice that active participation could result in discipline. The
Position Statement does not express an opinion on the issue
of capital punishment generally, nor was it intended as an in-
President’s Message
Physician Participation in Executions:
The Gordian Knot of the Medico-Legal Arena.............................1
*H. Arthur McCulloch, MD
Improving Your Practice Management Through
Outsourcing: Part I—Managed Care Contracting
and Billing and Collections.....................................................3
*Marjorie A. Satinsky, MA, MBA
Physician, Protect Thyself!..........................................................6
*A North Carolina Physician
Tamper-Proof Prescription Pads Mandate
Postponed until April 1, 2008..............................................9
*Nancy H. Hemphill, JD
The Controlled Substances Reporting System:
A Useful Tool for Practitioners............................................10
*Nancy H. Hemphill, JD
Candidates Sought for Membership on
Medicaid Drug Utilization Review Board............................11
*Glenda Adams, PharmD, RPh
NCMB Policy Committee Continues
Study of Position Statements...............................................11
General Assembly Makes Historic Changes
to Medical Practice Act........................................................12
*Thomas W. Mansfield, JD
Governor Appoints Thelma C. Lennon, of Raleigh,
to North Carolina Medical Board.........................................14
Board Actions: 05/2007-07/2007............................................15
Change of Address...................................................................24
Compliance Reviews for Nurse Practitioners and
Physician Assistants in North Carolina..................................24
Board Calendar.................................................................................24
General Assembly Makes
Historic Changes to MPA
Page 12
NCMB Forum
North Carolina Medical Board
The Forum of the North Carolina Medical Board is published four
times a year. Articles appearing in the Forum, including letters and
reviews, represent the opinions of the authors and do not necessarily
reflect the views of the North Carolina Medical Board, its members or
staff, or the institutions or organizations with which the authors are af-filiated.
Official statements, policies, positions, or reports of the Board
are clearly identified.
We welcome letters to the editor addressing topics covered in the
Forum. They will be published in edited form depending on available
space. A letter should include the writer’s full name, address, and tele-phone
number.
forum N C M E D I C A L B O A R D
Raleigh, NC Vol. XII, No. 3, 2007
H. Arthur McCulloch, MD
President
Charlotte
Term expires
October 31, 2008
Janelle A. Rhyne, MD
President Elect
Wilmington
Term expires
October 31, 2009
George L. Saunders, III, MD
Secretary
Shallotte
Term expires
October 31, 2009
Ralph C. Loomis, MD
Treasurer
Asheville
Term expires
October 31, 2008
Donald E. Jablonski, DO
Etowah
Term expires
October 31, 2008
Thelma C. Lennon
Raleigh
Term expires
October 31, 2008
John B. Lewis, Jr, LLB
Farmville
Term expires
October 31, 2007
Robert C. Moffatt, MD
Asheville
Term expires
October 31, 2007
Michael E. Norins, MD
Greensboro
Term expires
October 31, 2007
Peggy R. Robinson, PA-C
Durham
Term expires
October 31, 2009
Sarvesh Sathiraju, MD
Morganton
Term expires
October 31, 2007
R. David Henderson, JD
Executive Director
Publisher
NC Medical Board
Editor
Dale G Breaden
Associate Editor
Dena M. Konkel
Street Address
1203 Front Street
Raleigh, NC 27609
Mailing Address
PO Box 20007
Raleigh, NC 27619
Telephone
(919) 326-1100
(800) 253-9653
Fax
(919) 326-0036
Web Site:
www.ncmedboard.org
E-Mail:
info@ncmedboard.org
PrimumNon Nocere
NORTH CAROLINA
MEDICAL BOARD
April 15,1859
Primum Non Nocere
2
strument for halting executions. Rather, it is targeted
at the narrow issue of the ethical implications of phy-sician
involvement in executions.
After the Board issued the Position Statement, the
pot continued to boil when lawyers for several con-demned
inmates filed for a temporary restraining or-der
on grounds that their clients’ constitutional rights
to an execution free of undue pain and suffering were
being violated. The resulting court action stayed sev-eral
scheduled executions.
In response, the Department of Correction revised
the Execution Protocol to include the requirement
that a “doctor shall monitor the essential body func-tions
of the condemned inmate and shall notify the
Warden immediately upon his or her determination
that the inmate shows signs off undue pain or suffer-ing.”
The use of a processed EEG monitor (BIS) is
also included. This revision was done without con-sultation
with the Medical Board, the Medical Soci-ety,
or the physicians of the penitentiary.
As the issue developed, the Department of Correc-tion
filed a lawsuit against the Board, alleging that
executions are not medical procedures and, thus, the
Board cannot discipline a physician for participat-ing.
However, the Medical Practice Act authorizes
the Board to discipline its licensees for misconduct
regardless of whether or not it involves a medical
procedure. Indeed, the Board frequently disciplines
physicians for non-medical conduct, eg, boundary
violations, violations of patient confidentiality, and
disruptive behavior. The authority of the Board to
enforce the ethics of the medical profession is impera-tive
for protection of the public safety and well-being
and for maintaining the integrity of, and public trust
in, the medical profession.
Significantly, the Department of Correction has not
challenged the Board’s conclusion that active physi-cian
participation in executions is unethical. Rath-er,
the judge has made an initial determination that
the Board does not have the authority to discipline
a physician for active involvement in executions. At
the time of this writing, the Board is filing an appeal
from that decision. Meanwhile, in a separate proceed-ing,
another judge has ordered that the Council of
State reconsider the Execution Protocol.
It is difficult at this time to forecast whether this
entanglement will ultimately be resolved by the judi-cial
or legislative sword. However, whether the courts
or the legislature agree with the Board or decide to
limit the Board’s disciplinary authority in some man-ner,
the fact will remain that physician participation
in executions is unethical.
______________________
*The Board has 30 Position Statements that serve as inter-pretive
guides on a variety of topics important to physicians.
These typically come about as a response to complicated ques-tions
of conduct brought to the Board’s attention through
complaints and inquiries. They are intended to provide a safe
harbor for licensees from disciplinary action by the Board.
If you are like most phy-sicians
in private practice,
you know that running your
business can sometimes seem
as challenging as practicing
medicine. Even if you have
supplemented your clinical
training with a business de-gree,
you realize that you are
dealing with a wide variety
of issues that include quality
of care, patient satisfaction,
financial management, peo-ple,
and supporting information technology.
My clients tell me that the longer they practice, the
more complicated practice management becomes. Man-aged
care companies and government payers continue
to impact your revenue in unpredictable and usually
negative ways. Patients expect more from their physi-cians
and don’t hesitate to say so. You keep operating
expenses at a reasonable level by asking your staff to
assume more responsibilities. If you are a small practice
with 10 or fewer physicians, your practice manager, if
you have one, may be deluged with the details of day-to-
day operations. The very thought of taking respon-sibility
for special projects that require a new knowledge
base may be overwhelming.
You may be able to improve the management of your
practice by outsourcing one or more functions that re-quire
specialized expertise that you don’t have and are
unlikely to hire. In this two-part article, I review five
functions that you may be able to outsource to your
advantage: managed care contracting, billing and col-lections,
information technology, human resources, and
financial planning. For each of these areas, I identify
the problems that outsourcing may help you address,
review the advantages and disadvantages of outsourc-ing,
and offer helpful hints for selecting a vendor or
consultant to help you. In this first part of the article, I
deal with managed care and billing and collections. In
the second part, which will appear in the next number
of the Forum, I’ll cover information technology, human
resources, and financial planning.
Managed Care
Let’s face it—physicians would be happy if managed
care would go away. For the time being, however, man-aged
care is here to stay, and for most practices, it ac-counts
for a very large proportion of practice revenue.
Although revenue from managed care contracts is very
No. 3 2007 3
Ms Satinsky
Improving Your Practice Management Through
Outsourcing: Part I—Managed Care Contracting and
Billing and Collections
Marjorie A. Satinsky, MA, MBA
President, Satinsky Consulting, LLC
important for most physician practices, ask any group
of practice managers how they handle managed care
and you’ll get a similar response. Most managers hate
it, avoid it, and rarely give it the attention that it war-rants
given its place as the financial foundation of the
practice. Here’s what I see on a regular basis.
• Many practices don’t know which managed care con-tracts
they have in place, when they last negotiated
these agreements, the contract terms, and the financial
obligation of the payers. It goes without saying that
if you don’t know what you have, you can’t determine
whether or not your situation is good or bad.
• Although North Carolina requires payers to give pro-viders
CPT-code-specific reimbursement for the most
frequent 30 codes annually (and for the full list of
codes upon request), many practices don’t ask for this
information. If I ask about their reimbursement level,
physicians and practice managers tell me they’ll check a
recent sample of payments by the plans. Unfortunately,
that type of check won’t tell me if the actual payment
matches the expected payment as stated in the contract
between the plan and the practice.
• Although many practice management systems have
features that compare actual with expected reimburse-ment,
many practices don’t recognize the importance
of using this function. Well-run practices make this
comparison regularly by automatically checking each
remittance when it comes in or by running a regular
report.
• As one managed care representative said to me, “We
generally don’t go out and offer to pay physicians more
money. If you want an increase, you have to ask for it.”
There are occasional across-the-board fee increases, but
in most cases, physicians must take the initiative.
• Each managed care plan has a unique method of re-imbursement.
Some plans pay a fixed percentage of
Medicare, but not all plans relate this percentage to
the same Medicare year. Other plans use proprietary
fee schedules. It’s difficult to compare reimbursement
across plans—unless you know what information you
need and how to make the comparison.
• Although one might think that all physicians receive
the same amount of money for the same services, that’s
not how it works. The size of your practice, your loca-tion,
and your importance to the network in which you
participate are all contributing factors.
Outsourcing your managed care to a consultant who
looks at both rates and contract language makes sense
for the following reasons.
• Consultants that represent multiple clients have work-ing
relationships with the managed care plans. They
know whom to call at each plan and how to frame the
“You may be
able to improve
the manage-ment
of your
practice by out-sourcing
one or
more functions
that require
specialized
expertise”
4 NCMB Forum
request for a rate increase in a way that is most likely to
get a favorable result.
• Contract language review is a tedious task. You must re-view
not only the legal agreement, but also information
that is contained in detailed administrative manuals and
extensive Web sites. Consultants with experience in re-viewing
and organizing this information into an easily
understandable format can save you hours of reading
and analysis.
• Depending on your selection of a managed care consul-tant,
you can pick someone who will teach your staff
what to do. Once you learn the steps, you can decide
whether or not you want to ask the consultant to do all
your contracts or teach your staff how to do the work.
I see only one disadvantage with outsourcing man-aged
care contracting. If you engage a consultant that
insists on doing all the work for you without teaching
you how to do it yourself, you’ll set up a dependency re-lationship
that you may not need or want in the future.
If you want to outsource your managed care con-tracting,
here are questions you should ask potential
consultants.
1. What is your experience with managed care contract
review and rate negotiations? Consultants vary in
their experience. Some have been doing managed
care work for many years, and others are relatively
new at the game.
2. What kind of practices has the consultant represented?
Every practice is different, so look for a seasoned con-sultant
who has worked with practices in your spe-cialty.
3. Is the consultant willing to work with you on some
but not all of your managed care contracts? It is im-portant
to know what all the plans are paying you,
but in some instances, the reimbursement is fine as
it is. Some consultants insist that they work on each
and every managed care contract that a practice has in
place; others are amenable to working on those that
the practice believes are the most important.
4. How will the consultant work with your practice?
Consultants come in three varieties. “Messiahs” do
the work for you; they save the day. Other consul-tants
convince you that you can’t get along without
them—ever. You are best off with a consultant who
fosters a collaborative relationship with your practice.
Let the consultant teach you what he/she is doing, and
then decide if you want to farm out all of the work or
do some of it yourself.
5. How will the consultant charge you for the service?
The most common methods for pricing managed care
consultation are on an hourly basis or by the project.
In my experience as a consultant, it is hard to predict
how many hours each project will take. I know the
average number of hours I spend reviewing contracts,
administrative manuals, and Web sites, but I don’t
know when I begin a project for a new client how long
it will take me to organize baseline information. I also
can’t predict how many rounds of negotiations will be
required to reach a mutually acceptable conclusion.
6. What do references say about the consultant? You
can’t ask other practices about reimbursement rates,
but you can ask about overall results, accessibility, and
timely response to your needs. You don’t want a con-sultant
who has so many other clients that you don’t
get the attention for which you have paid. You can
also ask the North Carolina Medical Society or your
state professional organization for suggestions.
Billing and Collections
You’ve probably heard the term “revenue cycle man-agement.”
You need to set your fees at an appropriate
level, negotiate your managed care contracts to bring
in reasonable reimbursement, and make sure that your
billing and collections processes support your efforts.
Even if you regularly reevaluate your fee schedules and
renegotiate your managed care contracts, the billing
and collections portion of the revenue cycle process may
malfunction, causing receivables to skyrocket. Here are
the problems that I commonly see.
• In many practices, billing and collections is account-able
to a practice manager who lacks the experience to
supervise the function. Many practice managers began
their careers in clinical positions and worked their way
up the ranks. If their previous responsibilities never
included billing and collections, they may lack the ex-pertise
to supervise the billing and collections staff.
• High staff turnover is another common problem. Let’s
face it; asking for money all day long, primarily over
the telephone, can be a frustrating experience. In my
years as a practice management consultant, I’ve met
only one collections person who loved what she was
doing. In dealing with patients, as opposed to payers,
she actually functioned somewhat as a social worker. If
burnout in your billing and collections staff is common,
it is costly to your practice to repeatedly recruit, hire,
and train—over and over again.
• Inability to focus is a common problem. In many small
practices, the billing and collections staff multi-task, and
they may not focus on the billing and collections aspect
of their job with the concentration needed to get the
job done. I’ve seen practices where the billing and col-lections
people are not methodical in the way in which
they organize their work. Rather than batch the unpaid
claims for a single payer, they call or e-mail about indi-vidual
claims, dragging out the resolution process.
• Billing and collections staff may lack good working re-lationships
with payers. Payers are more responsive to
problems if they are consistently dealing with a single
individual from your practice rather than with multiple
people.
• Self-pay by patients is becoming more and more im-portant
for several reasons. Employers are shifting the
burden of health insurance to employees, and some
are now opting for health savings accounts. People
who are between jobs or are self-employed may have
no health insurance at all. Many practices have a long-standing
tradition of not asking patients for money, and
staff may have trouble transitioning to a different mo-dus
operandi that requires payment at time of service.
Outsourcing billing and collections has both advan-
“In many prac-tices,
billing
and collections is
accountable to a
practice man-ager
who lacks
the experience
to supervise the
function”
No. 3 2007 5
tages and disadvantages. The following are the advan-tages.
• You may reduce your accounts receivable and bring
more revenue into your practice sooner than you are
doing now.
• Within your practice, you can focus on clinical care, not
billing and collections.
• You’ll have access to experts in coding, management,
and insurance who will focus on these tasks and not be
diverted by other pressing needs.
• Staff turnover and the accompanying costs of recruit-ing,
hiring, and training new staff may decrease.
• As physician owners of your practice, you’ll have more,
not less control over billing and collections processes
than you would if these are dependent on your in-house
personnel—who keep leaving.
• You free up space previously taken up by billing hard-ware.
• You can reduce the number of phone calls about billing
and collections that come directly into your practice.
Billing and collections companies answer the phone
with your practice name, so patients do not think their
calls are being diverted.
• You increase the hours of coverage for questions related
to billing and collections.
Outsourcing billing and collections can have three
disadvantages. You can anticipate and address all of
them.
• Your practice manager may be very threatened by the
outsourcing of billing and collections. If, however, the
decision to outsource allows more time to concentrate
on other projects, he/she may welcome the approach.
• Your practice may feel as if it has lost control over its
receivables. Indeed you do give up the responsibility
for day-to-day aspects of billing and collections, but
you don’t give away your responsibility to direct your
vendor in how the work is done. Here’s an example:
the vendor sends letters to patients who don’t pay, and
your practice, not the vendor, should write those letters
and decide when to send them..
• As you plan the information technology support for
your practice (ie, practice management system, elec-tronic
health records—EHR, and/or functional Web
site), you should be looking at a practice management
system and an EHR system that are integrated (ie, built
off the same operating platform). If the vendor that
you select for outsourcing your billing and collections
uses a practice management system that does not have
EHR or that has an EHR system that you do not like,
you will limit your choice of information technology
applications that appropriately support your practice.
If you would like to explore outsourcing billing and
collections, here are questions you can ask potential ven-dors.
1. Is the vendor independently owned or a subsidiary
of another organization? One of my clients that had
previously been managed by a hospital and that had
bought the practice back ruled out a potential vendor
because that vendor was owned by a hospital.
2. What are the vendor’s history and future plans?
3. How does the vendor service new clients? Does it
add new staff or assign additional clients to current
staff?
4. What is the vendor’s attitude toward practices of your
size and specialty? Some vendors are only interested
in large practices, so make sure you ask this question
early in your discussions so you can rule out vendors
that won’t meet your needs.
5. What practice management system does the vendor
use? Most vendors will ask you to use the particular
practice management software that they use. Some
will give you options. One of my clients selected
a billing and collections vendor that used the same
practice management system that was already in
place and found the transition relatively easy.
6. Can you check vendor references and make a site visit
to client sites to see how the system works from the
client’s perspective?
7. Can you visit the vendor’s site and meet the staff that
will handle your account? I accompanied one client
on two vendor site visits. The experience level and
professionalism of one vendor clearly outshone that
of the other and contributed to the final selection.
8. Check on staffing. Who will handle your account,
and what is the staff turnover? Is there a certified
coder on site?
9. How does the vendor charge? Some vendors charge
a percentage of net collections and others charge a
flat monthly fee. What is the fee for software licens-ing
and set-up? What will you spend on hardware
and connectivity?
10. Is staff training included in the start-up fee or is it
extra? How does the vendor charge for ongoing
training?
11. Will the vendor help you clean up past claims, and
if so, will this service be included or will there be an
extra charge?
12. What is the vendor’s target for accounts receivable?
You should be able to get targets for percentage of
claims over 90 days old and for average days in re-ceivables.
13. Given your particular situation, what financial savings
does the vendor expect to produce for your practice?
14. What are the details of the transition process and how
long will it take?
15. How frequently will the vendor meet with your prac-tice?
16. What reports will you get on a regular basis? If the
practice management system that the vendor uses
does not produce clear reports that can help your
practice, you may find yourself struggling to under-stand
the financial health of your practice.
………………………………
Acknowledgements
Karen Diamond, CFP, CIMA, and Ed Barber, CFM, formerly
with Merrill Lynch; and Jean Bailiff, Physician Discoveries.
__________________________
Ms Satinsky is president of Satinsky Consulting, LLC. She earned
her BA in history from Brown University, her MA in political science
from the University of Pennsylvania, and her MBA in health care
administration from the Wharton School of the University of Penn-
“Outsourc-ing
billing
and collections
can have three
disadvantages.
You can an-ticipate
and
address all of
them”
6 NCMB Forum
sylvania. She is the author of three books: Medical Practice Man-agement
in the 21st Century (Radcliffe Publishing, 2007), The Foun-dation
of Integrated Care: Facing the Challenges of Change (American
Hospital Publishing, 1997), and An Executive Guide to Case Manage-ment
Strategies (American Hospital Publishing, 1995). The Forum
has published several articles by Ms Satinsky, including Managing the
Implementation of HIPAA and the Privacy Rule, in #4, 2002; How
to Determine If Your Practice Could Use a Professional Practice Ad-ministrator,
in #2, 2003; Using Information Technology to Improve
Patient Care and Communication: A Practical Guide – Part 1, in #1,
2004; Using Information Technology to Improve Patient Care and
Communication: A Practical Guide – Part 2, in #2, 2004; Electronic
Medical Records and the Development of Electronic Health Records
and Electronic Patient Records, in #3, 2004; Implementation of the
HIPAA Security Rule in #4, 2004; What Are You Doing About
Health Care Quality in Your Practice, Part I, #1, 2006 and Part II,
#2, 2006. An adjunct faculty member at the University of North
Carolina School of Public Health, Ms Satinsky is a member of the
North Carolina Medical Society Quality of Care and Performance
Improvement Committee, Medical Group Management Associa-tion,
and North Carolina Medical Group Managers. She may be
reached at (919) 383-5998 or margie@satinskyconsulting.com.
Physician, Protect Thyself!
A North Carolina Physician
I am a physician in North Carolina, board certified
in anesthesiology and pain management. I trained
at one of the best medical schools in the country and
completed an excellent residency program. I served
honorably as an officer in the armed services. After
coming to North Carolina, I built a successful practice
and found a great deal of satisfaction in helping pa-tients
with severe pain.
The physician who offers pain management care to
his/her patients discovers very quickly that the patients
being seen are generally extremely ill. These patients
suffer chronic, debilitating pain, and in many cases pal-liative
care is offered where there is no other meaning-ful
care or cure available. The “symptom” of severe
pain, which often accompanies trauma or disease like
cancer, finally becomes the primary disease, at least in
terms of what may be treatable.
We all became physicians in order to help others, to
offer care and solace to our patients. Our patients in
pain come to us for that help, and they often demand
much from their physicians. Often, it becomes dif-ficult
for the physician to maintain the clear, definitive
boundaries that are so necessary to keep both the pa-tient
and the physician healthy and productive.
Neglecting My Own Well-Being
In the area where I practiced, there were few pain
management physicians; this is, unfortunately, the case
in many counties in North Carolina. Patients, driven
by the agony and frustration of unrelenting pain, of-ten
seek relief from nonphysicians, or from foreign
markets. Most of the time, these “treatments” don’t
work—the treatment may actually exacerbate the
pain—and the patient is forced once again to try an-other
remedy. There is an overwhelming need in these
people’s lives for some—any—relief from pain.
As a “workaholic,” I put no limitations on the de-mands
I made of myself or the demands I allowed oth-ers
to make of me. I saw patients long into the evening,
resulting in excessively long workdays. If there had
been 36 hours in the day instead of 24, I could have
filled that time with more patients. I had medical staff
privileges at two hospitals and saw walk-in patients
at both hospitals. I was willing to drive hundreds of
miles each week to visit patients; back and forth, be-tween
the two facilities daily. In addition, I took call
(much of it involving my post-surgical patients) and
attended to my busy office practice. I played the role
of Superman. When other physicians had cases that
no one else could or would handle, I was the “go-to”
pain management specialist. The more difficult the
challenge, the more quickly I accepted it. I wanted
above all to make a difference in my patients’ lives;
unwittingly, I was setting myself up for a fall.
It was impossible to schedule my days and nights in
this way without ignoring my own well-being. Grad-ually,
I lost sight of those necessary and appropriate
boundaries between my personal life and professional
life. My entire life was out of control, but I was so
busy, so tired, so stretched that I wasn’t even aware of
it. As events continued to spiral more and more out
of control, I thought, of course, everything remained
under my control.
Eventually, my hectic lifestyle resulted in behavior
that was erratic enough to attract the attention of a
person who, erroneously, reported me to the admin-istration
of one of the hospitals as being on drugs.
When approached by a North Carolina Physicians
Health Program (NCPHP) member, I not only de-nied
the charge but was quite upset that I had been
turned in; I certainly was not a user or abuser of drugs!
Thank you, NCPHP, but I can handle this myself, I
thought. Unfortunately, my way of handling the situa-tion
was not to cut my work load or take care of myself
personally.
Of course, the fact that I knew I wasn’t on drugs
didn’t keep the gossipers from continuing to talk: my
lifestyle was as chaotic as ever, my demeanor just as
frenetic, and I’m sure, in hindsight, that I was missing
cues right and left that I was being watched. If some
of the folks watching me were waiting for me to prove
I was taking drugs, it didn’t happen. But if they were
waiting for me to prove I was in trouble, I gave them
all the proof they needed.
In what was an out of the blue scenario for me, I
was notified that my staff privileges at one of the two
hospitals where I practiced had been summarily sus-pended.
It was felt that I was a serious danger to pa-
“Gradually,
I lost sight of
those necessary
and appropri-ate
boundaries
between my per-sonal
life and
professional
life”
No. 3 2007 7
tients, they said. Me? A danger to patients? I took
great care of my patients and they cared for me. I
didn’t understand; surely there must be some mistake.
Charges were levied that were biased, based on gos-sip,
and untrue! To add insult to injury, the hospital
notified the North Carolina Medical Board and the
National Physicians Data Bank within two hours of
notifying me. Almost immediately, the Medical Board
requested that I voluntarily surrender my medical li-cense.
I had not yet realized the consequences of years
of neglect of my own well-being. My chaotic personal
life and unrealistic professional demands had caught
up with me. But at that time I felt my life was crash-ing
down around me. I had never been so angry, so
frustrated, so alone, and so afraid. How could this be
happening to me?
Learning to Concentrate on Me
Thankfully, at a time I felt I couldn’t fall any further,
a miraculous new experience presented itself and lifted
me up. Through my attorney, I reestablished contact
with the NCPHP. As I mentioned, I had an earlier en-counter
with the NCPHP, when I was sure I didn’t
need any help! I am deeply grateful that they still had
faith in me. With the encouragement of the NCPHP, I
entered an inpatient treatment facility, and there began
the miracle. For the first time in years, I was able and
encouraged to concentrate on ME.
I came to understand and accept what I had been
doing to myself. By not keeping myself healthy and
making sure I was enjoying a full and satisfying per-sonal
life, I could not have a productive professional
life. And only by remaining attentive to keeping my
professional life healthy could I offer meaningful care
to my patients. I eagerly embraced the knowledge and
experience of my care providers. I learned more about
what was driving me and recognized that I wasn’t
Superman after all. But I could continue being the
excellent physician I knew I had been. By paying at-tention
to my physical health, my emotional health,
and my spiritual health (not always in that order!), my
demeanor changed without effort. I lost the frantic,
over-extended personality and found the calm, reas-suring
one that instilled, for my staff, my peers and
my patients, a sense of confidence in me. I learned to
properly schedule my work day, keeping in mind how
many hours it actually contains and how much call I’ve
taken.
The charges and claims made against me were, for
the most part, unfounded; but the problem was defi-nitely
there, and even though I wasn’t yet a danger to
patients, it might have been only a matter of time. Too
many patients, too little sleep, a missing report: expe-riences
we have all shared, but in different contexts,
different places.
Betrayal of Trust
Eventually, I regained my North Carolina medical
license with some hourly and surgical limitations that
were gradually lifted. My license is now full and un-restricted.
I opened a new medical practice, and al-though
I was working a much lighter schedule than
before, I soon realized that I needed another employee
to work in the clinical area. In the past, I had several
unsuccessful contract experiences with medical assis-tants
from temporary hiring services, and I finally de-cided
I had to bite the bullet and hire the best clinical
assistant I could afford. I thought a registered nurse
was out of the question, simply too expensive. One
applicant, however, Christine (not her name), was a
former registered nurse who had lost her license due
to substance abuse. Christine led me to believe that
she had completed treatment and was in recovery. She
came highly recommended. I was extremely impressed
with her credentials, and when I met her I found her to
be pleasant, thoughtful, and articulate. I immediately
considered hiring her.
Before hiring Christine, I discussed with her our
practice environment and the safety parameters we
had set up. I was completely frank about my prior
difficulties and I wanted to make sure she understood
the importance of strictly following our practice poli-cies
and procedures. We also talked about her desire
to work in a safe and supportive environment and how
that could assist her in her own recovery. Wanting to
make sure I handled this prudently, and to demonstrate
due diligence, I contacted the Drug Court, which was
in charge of Christine’s rehabilitation program. I
talked to the Judge who was involved in her case to
determine whether he felt Christine would be a good
candidate for the position in my practice. He thought
she’d be a perfect fit. I also sought the opinion of my
Caduceus peers and my local contact with the NCPHP.
Certainly, if anyone I approached had advised me not
to hire Christine, I would have honored that advice.
But, since all parties agreed, Christine’s hire seemed
beneficial for both of us. I hired her with every expec-tation
that would be the case.
My DEA license had not been restricted when I vol-untarily
surrendered my medical license because there
were no issues regarding use or distribution of phar-maceuticals.
Even though my office practice is pain
management, the only controlled drugs kept on the
premises were alprazolam and hydromorphone. Both
were in pill form and sealed in numbered blister packs.
Both medications were kept in the front office, secured
in a double-locked safe. No injectable narcotics were
kept on the premises. This was all explained to Chris-tine.
Christine was never permitted to medicate pa-tients.
She had access to only one prescription book
with numbered prescriptions, for which she was solely
accountable. Each written prescription produced a
carbon copy. No discrepancies occurred. Christine
appeared to adjust quickly to her new job.
After a few months, Christine’s performance, which
had been excellent, began to decline. Her attention
“Christine led
me to believe
that she had
completed treat-ment
and was
in recovery. She
came highly
recommended”
8 NCMB Forum
to detail was failing. This was a gradual process; she
continued to arrive promptly and appeared to have
no problem performing her professional duties. Two
months into her employment, Christine tested posi-tive
on a urine screen required by the Drug Court.
With my office manager, I immediately met with her
to discuss the test results. Christine explained she had
gained weight over Thanksgiving and had been taking
diet pills. She assured us she had absolutely no idea
an over-the-counter diet pill would produce a positive
reading on her urine screen. We both counseled Chris-tine
about avoiding any substance that could test posi-tive.
I also reminded her that it was critical nothing
happen that could jeopardize my career and damage
my new practice. We told Christine in no uncertain
terms that her employment would be immediately ter-minated
if there were another positive urine screen.
She remained an enrollee of Drug Court Phase 3,
and she was continued on a more stringent outpatient
recovery plan as a result of the positive test. To the
best of my knowledge, Christine adhered to all the re-quirements
of her treatment plan, including random
urine toxicology screens.
A month later, Christine had her regular drug screen.
The next day, Christine’s housemate called the office to
report Christine would not be coming in because she
was not feeling well. Later that morning, I received a
call from an emergency room physician. He explained
that he was taking care of Christine and he needed to
know if I was missing any injectable narcotics from
the office. The physician said it was vital to have this
information to properly treat her for an overdose. I as-sured
him that no injectable narcotics were kept in the
office and that our daily controlled substance inven-tory
showed no discrepancies. The ER physician told
me Christine had been given dopamine to support her
blood pressure and Narcan to reverse narcotic over-dose
symptoms. After stabilizing, she was transferred
to a ward bed at the hospital for further monitoring.
A Gap in the System
My office manager and I immediately investigated
possible sources in our office for Christine’s drug ac-cess.
I telephoned the North Carolina Medical Board
to report this incident, as well as the local DEA agency.
An investigator from the local agency visited the office
that same day to evaluate the situation. After meeting
with him, my office manager and I continued to inves-tigate
the possibility of drug diversion from the office.
The local investigator agreed to notify all nearby phar-macies
and ask them to fax me a list of patients that
had been prescribed controlled substances under my
name. I reviewed those but was unable to identify any
unauthorized or fraudulent prescriptions.
It was not until four days later that we discovered
Christine’s source during a routine delivery of office
supplies. Unknown to me or my staff, the delivery
also included six vials of nalbuphine (Nubain). When
my office manager and I reviewed delivery invoices
for existing supplies, we discovered there were six 10
mg vials of Nubain that had been ordered in previous
weeks. These were ordered under the auspices of my
practice. No such orders of Nubain had been autho-rized.
Despite an extensive search, there remained no
accounting for the additional six vials of Nubain.
In due course, it
became clear that
Christine had been
secretly ordering the
Nubain vials. It is
equally clear that no
one else was aware
that the orders had
been placed, let alone
that they had been
diverted. Because
Nubain is not a con-trolled
substance,
no DEA number or
prescription is re-quired.
We discov-ered
that Christine
did not even require
my medical license
number to place orders for Nubain; the fact that the
order came from a medical office was sufficient autho-rization
for the supplier to ship the vials. As a former
RN, Christine was aware of this loophole. She was
also aware that she could time her injections of Nubain
to avoid positive urine test results.
A printed form was routinely used to fax the orders
for supplies. All supplies were ordered by noting the
number requested. Evidently, Christine penciled in
orders for Nubain and then erased the hand-written
entry after receiving the order. After unpacking and
counting the supplies to assure the order was com-plete,
Christine destroyed the accompanying invoices.
We had no reason to believe that her reconciliation of
items ordered to those received differed at all.
Having determined the source of Nubain diversion,
I again contacted the local DEA agent to further in-vestigate
this matter. It seemed incredible to me that
Nubain could be so easily acquired. Nalbuphine is a
synthetic opioid agonist/antagonist and is a potent an-algesic;
its analgesic potency is essentially equivalent
to that of morphine on a milligram basis. It impairs
physical and mental abilities, and physicians are advised
to use extreme caution when prescribing for patients
with former opioid dependencies/addictions.
In addition, Nubain is extremely inexpensive. A 10
mg vial of Nubain costs a mere 79 cents. Therefore,
in the context of invoice payments totaling hundreds
to thousands of dollars, the nominal additional charges
for Nubain could easily escape detection. In hindsight,
this harrowing scenario lends support to the concern
that this drug may be a very popular “drug of choice”
“Evidently,
Christine pen-ciled
in orders
for Nubain
and then erased
the hand-writ-ten
entry after
receiving the
order”
Three days before the
tamper-resistant prescrip-tion
pad requirement was
to go into effect, Congress
passed legislation pushing
back the implementation
date until April 1, 2008.
The new mandate had been
included in a federal budget
bill (Section 7002(B) of
P.L. 110-28, the US Troop
Readiness, Veterans’ Care,
Katrina Recovery, and Iraq
Accountability Appropriations Act of 2007) enacted
in May 2007. Federal guidelines were issued August
17, while the North Carolina Department of Health
and Human Services, Division of Medical Assistance
(DMA), published theirs on September 6, 2007. Fed-eral
law initially set the effective date as October 1,
2007.
Given the extremely short time frame for educating
those affected by it and implementing the act, many
professional associations, health care providers, state
Medicaid directors, and others protested, and appar-ently
Congress listened, delaying the effective date by
six months.
The measure will apply to all handwritten prescrip-
No. 3 2007 9
for those who are in a position to order it, as Christine
did, in any clinical setting. Based on the results of the
narcotics investigation with which my staff and I fully
cooperated, no charges were brought against the prac-tice,
my staff, or me. I kept the Medical Board fully
apprised of the situation as it developed. Nevertheless,
with the continuing advancement, and ease, of elec-tronic
communications and the invitation this presents
to those who would use it to their own advantage, it
becomes even more imperative that the physician pro-tect
herself/himself.
Protecting Precious Gifts
I am very concerned about Christine’s well-being.
However, she endangered others and she placed my
practice and my career at risk, even though I am sure
that was not her intent. In addition, I put myself at
risk without meaning to. While I remain fiercely sup-portive
of other health care providers in recovery, and I
will continue to offer encouragement and assistance to
others in recovery, I simply cannot afford to hire a col-league
in recovery. This isn’t my preference; however,
in weighing the potential risk versus benefit involved
in such a situation, I have determined that I simply
cannot take the risk, primarily because I am a sole
practitioner. Despite a great support system, I have
no “safety net” for my practice; no partners to bridge
the gap in the event I am unable to work for even
a very short time. The financial and emotional toll
of again closing my practice doors is more than I
can even consider. The years after my hospitalization
were not easy. I lost my former medical practice, my
patients, my staff. My home and my financial secu-rity
were lost almost as quickly.
Nevertheless, I am a much happier, healthier, well-balanced
physician today. I am a much more careful
person; I manage my private practice in such a way
that it benefits my patients, my staff, and myself. I
am a happy man, a rare commodity these days. I
take time to engage in hobbies and to seek support
from, and offer it to, others. I recognize my health
and my career as precious gifts that I enjoy and pro-tect
daily.
__________________________
The author wishes to thank Donna Turner Eyster, JD, of
Raleigh, for her assistance in preparation of this article.
Ms Hemphill
Tamper-Proof Prescription Pads
Mandate Postponed until April 1, 2008
Nancy H. Hemphill, JD
NCMB Special Projects Coordinator
tions for recipients of North Carolina Medicaid. The
purpose of the law is to prevent alterations and forger-ies
of prescriptions and to protect the public health by
reducing drug diversion and illegal sales.
The requirement applies to all outpatient drugs, in-cluding
over-the-counter medications, for which state
Medicaid programs provide reimbursement. Excep-tions
include: drugs administered in hospitals, long
term care facilities, medical offices, and other inpatient
health care settings. Prescriptions that are transmitted
by e-mail, fax, or telephone will be acceptable. Refills pre-sented
prior to April 1 do not have to be resubmitted
on the new form. Neither does the law apply when a
managed care facility pays for the prescription. An
emergency prescription written on a non-compliant
form may be filled as long as a compliant prescription
is filed within 72 hours after the prescription is filled.
Out-of-state prescriptions must also meet the require-ment.
From April 1, 2008, until October 1, 2008, prescrip-tion
pads must only contain one out of three elements
of tamper resistance (although they can, of course, ful-fill
more). If a prescription pad meets any one of the
following requirements, its use is acceptable: (1) one
or more industry-recognized features designed to pre-vent
unauthorized copying of a complete or blank pre-scription
form; (2) one or more industry-recognized
“I simply can-not
afford to
hire a colleague
in recovery”
10 NCMB Forum
The Controlled Substances Reporting System:
A Useful Tool for Practitioners
Nancy H. Hemphill, JD
Special Projects Coordinator, NCMB
The North Carolina Controlled Substances Reporting
System (CSRS) went into operation on July 1, 2007. En-acted
by the state legislature in August 2005, the CSRS
requires the North Carolina Department of Health and
Human Services to establish and maintain a reporting
system for all prescriptions for Schedule II, III, IV, and V
controlled substances. It is hoped that the reporting sys-tem
will stem the epidemic of deaths from unintentional
drug overdoses from licit drugs, mostly narcotics. NCGS
90-113.71 states that the bill was “. . .intended to im-prove
the State’s ability to identify controlled substance
abusers and refer them for treatment, and to identify and
stop diversion of prescription drugs in an efficient and
cost-effective manner that will not impede the appropri-ate
medical utilization of licit controlled substances.”
Dispensing pharmacies must now report all of the fol-lowing
to the DHHS: the patient’s name, address, phone
number, and date of birth; the date of the prescription;
the prescription number; whether it’s a new prescription
or a refill; the metric quantity; estimated days of supply;
its National Drug Code; and both the prescriber’s and
dispenser’s DEA numbers. Pharmacies must report the
dispensing of controlled substances at least monthly until
July, 2008; thereafter, the data must be transmitted twice
a month. Physicians, physician assistants, nurse practi-tioners,
and others authorized to administer controlled
substances under NCGS Chapter 90 are not required
to report, even if they dispense these drugs. Other ex-emptions
apply to licensed hospitals or long-term care
facilities dispensing for inpatient use, and to wholesale
distributors of controlled substances.
Access to the state’s electronic data storehouse will be
limited. Those who can write and fill prescriptions will
be allowed access, as will individual patients; the SBI;
the courts (under a court order in a criminal action); the
Division of Medical Assistance; and monitoring authori-ties
from other states pursuant to an ongoing investi-gation.
The North Carolina Medical Board (and other
health care licensing boards) also can obtain the data, but
only if the Board is already conducting an investigation
of a licensee for prescribing irregularities. Note that the
law provides both civil and criminal immunity to licensed
health care providers who, in good faith, report or trans-mit
data pursuant to this law. The law also includes civil
penalties for those who breach its confidentiality provi-sions
or use the information for improper purposes.
Prescribers who wish to receive information from the
CSRS will have to file a one-time application for admis-sion
to the system and will receive a secure password.
While the application is not currently available on line,
it ultimately will be found at www.ncdhhs.gov/mhddsas.
Until then, contact Johnny.Womble@ncmail.net, or (919)
715-2771, ext 248. Once a physician is registered and
approved for access to the database, he or she can check
a patient’s prescription history on line. Physicians who
suspect that a patient is abusing and/or diverting narcot-ics
will finally have an easy and definitive way to verify
narcotic use and curb abuse. Here’s an example of how
this might work. A patient may go to her primary care
practitioner and request a refill for a one-time narcotic
prescription originally provided by her orthopedist.
With the patient still in the office, the physician can go
to his computer, access the CSRS database, and check
the patient’s controlled substance information. If what
the patient reports is true, the physician can write a re-fill.
The pharmacy will then relay the details of that pre-scription
to the database, so if the patient’s orthopedist
chooses to check on the patient, he or she can learn that
a refill was issued.
The physician also can discover whether the patient
features designed to prevent erasure or modification
of information written on the prescription by the
prescriber; or (3) one or more industry-recognized
features designed to prevent the use of counterfeit
prescription forms. Beginning October 1, 2008, pre-scription
pads must contain all three characteristics.
Under each of the three standards, a number of
different anti-tampering features are listed in a DMA
guidance letter. For example, the appearance of the
word “VOID” across the entire front of the prescrip-tion
blank when the prescription is photocopied or
scanned would satisfy the first provision. The second
provision might be met by using chemically treated
ink or paper that resists washing, erasure, and repro-duction.
The third would be met by inserting a one-inch
square logo of the individual, professional prac-tice,
professional association, or hospital on the upper
left corner of the prescription blank.
It is the duty of dispensing pharmacies to ensure
that prescriptions are in compliance with Section
7002(b). North Carolina pharmacists will not be
able to fill non-compliant paper prescriptions because
the Center for Medical Assistance states: “Prescrip-tions
reimbursed by NC Medicaid on noncompliant
prescription pads are subject to recoupment.” It is
likely that pharmacists will be calling physicians ask-ing
them to resubmit prescriptions by phone, fax, or
e-mail.
For more information, go to: www.dhhs.state.nc.us/
dma/prov.htm, and look under “What’s New.”
“Once a physi-cian
is registered
and approved
for access to the
database, he or
she can check a
patient’s pre-scription
history
on line”
No. 3 2007 11
has received narcotic prescriptions from other prac-titioners.
After checking the history of the patient’s
narcotic drug use, the primary care practitioner can
choose whether to counsel her about substance abuse
or take other action. It is hoped that immediate access
to a patient’s narcotic prescription history will be used
Candidates Sought for Membership on
Medicaid Drug Utilization Review Board
Glenda Adams, PharmD, RPh*
The North Carolina Division of Medical Assistance
(DMA) is looking for candidates who would like to be
considered for a North Carolina Medicaid Drug Utiliza-tion
Review (DUR) Board member position.
In accord with the Social Security Act of 1927 and
OBRA of 1990, the DUR program for outpatient drugs
assures that prescriptions to Medicaid recipients are ap-propriate,
medically necessary, and not likely to result in
adverse medical events.
The DUR Board consists of the DMA DUR coordi-nator,
five licensed and actively practicing physicians, five
licensed and actively practicing pharmacists, and two at-large
members with knowledge and expertise in one or
more of the following: prescribing of Medicaid covered
outpatient drugs; dispensing and monitoring of Medicaid
covered outpatient drugs; drug use review, evaluation, and
intervention; or medical quality assurance. Excluding the
at-large members, candidates must actively provide medical
NCMB Policy Committee Continues
Study of Position Statements
The Policy Committee of the North Carolina Medical
Board regularly reviews the Board’s Position Statements
and considers new statements. The Board’s licensees and
others interested are invited to offer comments on any
statement in writing to the chair of the Policy Commit-tee,
by e-mail (info@ncmedboard.org) or post (PO Box
20007, Raleigh, NC 27619). Comments are collected
over time and considered when the relevant statement is
reviewed or considered.
The Policy Committee discusses the Position Statements
in public sessions during regularly scheduled meetings of
the Board. The results are published on the Board’s Web
site and in the Forum before consideration by the Board,
allowing for further written comments to assist the Com-mittee
in preparing a final version for Board action.
Recently, the following statement was proposed for
consideration and comment.
End-of- Life Responsibilities and Palliative Care
Assuring Patients
Death is part of life. When appropriate processes have deter-mined
that the use of life-sustaining life-prolonging measures or
invasive interventions will only prolong the dying process, it is in-cumbent
on physicians to accept death “not as a failure, but the
natural culmination of our lives.”*
It is the position of the North Carolina Medical Board that pa-tients
and their families should be assured of competent, compre-hensive
palliative care at the end of the patient’s life. Physicians
should be knowledgeable regarding effective and compassionate
pain relief, and patients and their families should be assured such
relief will be provided.
Palliative Care
Palliative care is an approach that improves the quality of life
of patients and their families facing the problems associated with
life-threatening illness, through the prevention and relief of suffer-ing
by means of early identification, an impeccable assessment and
treatment of pain, and other physical, psychosocial, and spiritual
problems. Palliative care:
• provides relief from pain and other distressing symptoms;
• affirms life and regards dying as a normal process;
• intends neither to hasten nor postpone death;
• integrates the psychological and spiritual aspects of patient
care;
• offers a support system to help patients live as actively as pos-sible
until death;
• offers a support system to help the family cope during the pa-tient’s
illness and in their own bereavement;
care to Medicaid patients.
The DUR Board meets quarterly in Raleigh, NC
(1:00-3:00 PM, usually on the fourth Thursday of January,
April, July, and October). In meeting months, two hours
are compensated for attending the meeting and up to an
additional two hours for preparing for the meeting. The
preparation for the meeting involves reviewing reports/ar-ticles
that will be discussed at the meeting. In the months
when no meetings are scheduled, there is minimal time
involvement. Mileage is compensated in accordance with
State Budget Regulations (usually current IRS rate).
If you are interested in being notified when there is
a vacancy on the DUR Board or would like additional
information, please send an e-mail to Glenda Adams at
glenda.adams@ncmail.net.
__________________________
*Clinical Pharmacist, Clinical Policy Pharmacy Section, NC Divi-sion
of Medical Assistance.
to assist in proper prescribing and prevent abuse of
controlled substances by individuals who should not
receive them.
__________________________
See also NCGS 90-113.71 through 90-113.76; 10A NCAC
26E .0601 through 10A NCAC 26E .0603.
The North Carolina Gen-eral
Assembly passed sev-eral
bills this summer that
make historic changes to the
Medical Practice Act (MPA).
These changes are the most
comprehensive revision of
the MPA since the Board’s
inception almost 150 years
ago. These new laws resolve
litigation regarding the Board
member selection process,
give consumers more access
to pertinent physician information, remove archaic lan-guage,
reorganize/rewrite sections of the MPA that were
disorganized and confusing, add a much-needed defini-tions
section, specifically enumerate and also expand the
powers of the Board (including the power to enact rules
related to continued competence and the disposition of
medical records), and improve the Board’s ability to con-duct
hearings.
The following are highlights of new provisions. All
changes went into effect October 1, 2007, except the
12 NCMB Forum
• uses a team approach to address the needs of patients and their
families, including bereavement counseling, if indicated;
• will enhance quality of life, and may also positively influence
the course of illness;
• [may be] applicable early in the course of illness, in conjunction
with other therapies that are intended to prolong life, such as
chemotherapy or radiation therapy, and includes those inves-tigations
needed to better understand and manage distressing
clinical complications.**
There is no one definition of palliative care, but the Board ac-cepts
that found in the Oxford Textbook of Palliative Medicine:
“The study and management of patients with active, progressive,
far advanced disease for whom the prognosis is limited and the
focus of care is the quality of life.” This is not intended to exclude
remissions and requires that the management of patients be com-prehensive,
embracing the efforts of medical clinicians and of those
who provide psychosocial services, spiritual support, and hospice
care.
A physician who provides palliative care, encompassing the full
range of comfort care, should assess his or her patient’s physical,
psychological, and spiritual conditions. Because of the overwhelm-ing
concern of patients about pain relief, special attention should
be given the effective assessment of pain. It is particularly impor-tant
that the physician frankly but sensitively discuss with the pa-tient
and the family their concerns and choices at the end of life.
As part of this discussion, the physician should make clear that, in
some cases, there are inherent risks associated with effective pain
relief in such situations.
Opioid Use
The Board will assume opioid use in such patients is appropri-ate
if the responsible physician is familiar with and abides by ac-ceptable
medical guidelines regarding such use, is knowledgeable
about effective and compassionate pain relief, and maintains an ap-propriate
medical record that details a pain management plan. (See
the Board’s Position Statement on the Management of Chronic
Non-Malignant Pain Policy for the Use of Controlled Substances
for the Treatment of Pain for an outline of what the Board expects
of physicians in the management of pain.) Because the Board is
aware of the inherent risks associated with effective pain relief in
such situations, it will not interpret their occurrence as subject to
discipline by the Board.
Selected Guides
To assist physicians in meeting these responsibilities, the Board rec-ommends
Cancer Pain Relief: With a Guide to Opioid Availability,
2nd ed (1996), Cancer Pain Relief and Palliative Care (1990), Can-cer
Pain Relief and Palliative Care in Children (1999), and Symp-tom
Relief in Terminal Illness (1998), (World Health Organization,
Geneva); Management of Cancer Pain (1994), (Agency for Health
Care Policy and Research, Rockville, MD); Principles of Analgesic
Use in the Treatment of Acute Pain and Cancer Pain, 4th Edition
(1999)(American Pain Society, Glenview, IL); Hospice Care: A
Physician’s Guide (1998) ( Hospice for the Carolinas, Raleigh); and
the Oxford Textbook of Palliative Medicine (1993) (Oxford Medical,
Oxford).
(Adopted 10/1999; amendment proposed 5/2007)
*Steven A. Schroeder, MD, President, Robert Wood Johnson
Foundation.
** Taken from the world Health Organization definition of
Palliative Care (2002): (http:www.who.int/cancer/palliative/defini-tion/
en)
General Assembly Makes Historic Changes
to Medical Practice Act
Thomas W. Mansfield, JD
Director, Legal Department
Legislative Liaison
Mr Mansfield
Board member selection process provisions, which go
into effect January 1, 2008.
Board Member Selection Process
While the Governor has made the final decision regard-ing
appointments of physician members to the Board, the
North Carolina Medical Society (NCMS) provided the
nominees from which the Governor was required by stat-ute
to choose. The Board and the people of North Caro-lina
benefitted from the relationship between the Board
and the NCMS, but there was a great deal of criticism
from consumer advocacy groups, the media, and others
regarding the appointment process.
House Bill 8181 creates an independent Review Panel
that will make recommendations to the Governor regard-ing
appointments to seven physician seats and one seat held
by a physician assistant or nurse practitioner.2 The Review
Panel will make at least two recommendations for each
seat, and the Governor will pick from those recommen-dations.
The Review Panel will consist of nine members.
Eight of those members will be selected by the NCMS,
Old North State Medical Society, NC Osteopathic Medi-cal
Association, NC Academy of Physician Assistants, and
“There was a
great deal of criti-cism
from con-sumer
advocacy
groups, the media,
and others regard-ing
the appoint-ment
process”
No. 3 2007 13
NC Nurses Association Council of Nurse Practitioners.3
The ninth member will be one of the public members cur-rently
serving on the Board. Membership on the Board
does not require membership in any of the organizations
participating in the review and recommendation process.
House Bill 818 does establish other criteria for phy-sician
Board membership. Those criteria include having
an active license in good standing with the Board, hav-ing
an active clinical or teaching practice, having practiced
clinically for five years preceding appointment, providing
letters of recommendation, having no disciplinary history
with any medical board in the preceding 10 years, and hav-ing
no felony criminal convictions and no misdemeanor
convictions involving the practice of medicine. Applicants
must certify they understand that the Board’s purpose is to
protect the public, that they are willing to take disciplinary
action against their peers when appropriate, and that they
understand the significant time commitment required of
Board members.
Consumer Access to Physician Information
House Bill 818 also authorizes the Board to collect cer-tain
information from physicians and make it available to
the public. This will be in the form of a “physician profile”
system. The Board currently publishes on its Web site sig-nificant
information about its licensees in a user-friendly
format. That information will be expanded to include area
of practice, disciplinary actions by other medical boards
and agencies, felony and certain misdemeanor criminal
convictions, certain suspensions or revocations of hospital
privileges, and some information about professional liabil-ity
(so-called “malpractice”) payments. Failure by the phy-sician
to provide the required information to the Board
may result in disciplinary action.
The Board has spent much of the last year carefully
studying the issue of publishing information about profes-sional
liability payments. The Board cannot begin publish-ing
the payment information until it creates rules regard-ing
how the information will be collected and published.
The rulemaking process will take some months. Licensees
should pay close attention to the Forum for updates.
Reorganization, Codification, and Licensing
House Bills 818 and 13814 reorganize the licensing
provisions of the MPA and codify in the statute many pro-visions
previously covered specifically only by rule. Now,
the reader of the MPA can more easily find the licensing
provisions of the law. Archaic and outdated provisions are
deleted.
There are only two entirely new concepts in the licens-ing
laws. One is the requirement that all applicants for a
license be able to communicate effectively in the English
language. The other new concept is in the creation of a
Special Purpose License, which may serve several purpos-es
but was born of the need to facilitate bringing in excel-lent
physicians practicing in other states to North Carolina
on a temporary basis to consult with and teach our own
licensees.
Definitions
Section 1 of House Bill 818 creates an expanded defi-nition
of the “practice of medicine or surgery.” This new
definition includes advertising or holding out that one is
authorized to practice as a physician and using designa-tions
like “doctor.” Broadly speaking, the use of a des-ignation
like “doctor” by someone not licensed by this
Board is lawful only if the person using the designation
has a doctorate degree, is licensed by another health care
licensing agency, and makes it clear in which branch of the
healing arts he or she is practicing.
Powers and Duties
Section 5 of House Bill 818 includes two major de-velopments.
The bill authorizes the Board to regulate the
disposition and disposal of medical records and to appoint
a custodian for abandoned medical records. This law does
not apply to hospitals and other health care institutions,
only individual Board licensees. Looking to long range
changes, the bill authorizes the Board to develop and im-plement
methods of assessing and improving physician
practice and ensuring ongoing competence of licensees.
This new authority fits in with the national trend regard-ing
continued competence.
Conducting Hearings
The definitions section in House Bill 818 includes the
term “hearing officer,” which is defined as current and
past Board members who are an MD, DO, PA, or NP, as
well as current or retired members of the judiciary. Sec-tion
18 of the bill allows the Board to use these hearing
officers to conduct disciplinary and licensing hearings.
Historically, almost all hearings have been conducted by
sitting Board members. This provision expands the pool
of individuals who can hear Board cases and should per-mit
the Board to conduct more hearings and in a more
timely fashion.
Availability of Information to Complainants
Section 22 of House Bill 818 provides for greater access
to information on the part of patients and certain other
persons who complain to the Board about a licensee. The
new law requires that the Board inform the complainant
of the fact of and the basis for the Board’s disposition
of the complaint. For a number of years, the Board has
informed complainants in a very timely fashion of the dis-position
of their complaints along with providing limited
information about the nature or basis of the resolution
of the complaint. The Board is currently studying how
to strike the ideal balance between greater transparency
to complainants in the disposition of cases not requiring
formal disciplinary action and maintaining the effective-ness
of such actions, which are critical to ensuring safe
medical practice.
In addition, the new law gives the Board the discretion
to supply to the complainant the licensee’s written re-sponse
to a complaint, which was protected as confiden-tial
under the previous law. The Board is in the process
“The bill autho-rizes
the Board
to regulate
the disposition
and disposal of
medical records
and to appoint
a custodian
for abandoned
medical records”
R. David Henderson, ex-ecutive
director of the North
Carolina Medical Board, has
announced that Governor
Easley recently appointed
Thelma C. Lennon, of Ra-leigh,
as a public member of
the Board. She replaces E.K.
Fretwell, PhD, of Charlotte.
Mr Henderson said: “Ms Len-non
is fully committed to the
work of the Board and to the
health and safety of the people
of North Carolina. She brings a wealth of experience and
talent to the Board and we are deeply pleased to welcome
her.”
Ms Lennon earned her bachelor of science degree
from North Carolina Central University. She earned her
master’s degree from Boston University in guidance and
counseling and did further study of the subject at Harvard
University. She also completed graduate study in adult
education at North Carolina State University.
During her professional career, Ms Lennon served in
education as an instructor and dean of students at a num-ber
of academic institutions. Before retiring, she worked
as director of guidance and counseling for the North Caro-lina
Department of Education.
While working, Ms Lennon was actively involved in
the College Entrance Examination Board, National Voca-tional
Guidance Association (of which she was president),
National Career Guidance Association (of which she was
president and chairman of the Commission on Women),
14 NCMB Forum
Ms Lennon
the National Career Guidance Institute of the University
of Southern California (of which she was chairman), and
the Education Trust Advisory Council. To name only a
few of her many community services, she was actively in-volved
with the North Carolina Center for Public Policy
Research, Wake County Health Services, Inc, and Raleigh
Housing Authority.
Since her retirement, Ms Lennon has devoted much of
her time to volunteer activities focusing on health and edu-cation.
She is currently a counselor at the North Carolina
Department of Insurance’s Senior Health Insurance Infor-mation
Program (SHIIP), a member of the Board of Di-rectors
of the Carolinas Center for Medical Excellence, and
chairman for the Alliance for Medical Excellence. She is
also a member of the Wake County Community Advisory
Council for Nursing Homes and the Governor’s Advisory
Council on Aging.
From 1996 to 2000, Ms Lennon served as the first
American Association of Retired Persons (AARP) North
Carolina state president and was selected as an alternate
delegate to the White House Conference on Aging. In
2000, she was recognized by former Governor James
Hunt as one of twelve women to be named “Distinguished
Women of North Carolina.” She has received the Order of
the Long Leaf Pine, the AARP Andrus Award for Com-munity
Service, and most recently, was named Health Care
Hero by the Triangle Business Journal.
She coauthored a journal article on “Counseling the
Culturally Different” in the Ohio State University Educa-tional
Journal, and chaired the committee on the publica-tion
of Navigating the Course of Change in Guidance and
Counseling in Public Schools.
Governor Appoints Thelma C. Lennon, of Raleigh,
to North Carolina Medical Board
of determining under what circumstances it will release
to the complainant the licensee’s written response. The
Board will notify responding licensees of this possibility
and point out that the new law prevents the written re-sponse
provided by the Board from being admitted into
evidence in any civil proceeding against the licensee.
Supervising Laser Hair Practitioners
House Bill 7265 does not make changes to the MPA,
but it permits the NC Board of Electrolysis Examiners to
license laser hair practitioners (LHPs) to use laser devices
to remove or reduce unwanted hair. The licensees of that
board were previously limited to electrolysis. The new law,
in Section 6, requires that LHPs be supervised by a physi-cian
licensed by the Medical Board and that the physician
be on site or readily available. While the statute is silent as
to the need for a history and physical examination for each
patient receiving laser hair removal, this Board has made
clear in its Position Statement and disciplinary actions that
good medical practice requires such an examination prior
to initiating laser hair removal.
Conclusion
The preceding paragraphs do not cover every impor-tant
aspect of the new legislation. There are numerous
other provisions that may be relevant to a licensee of the
Board and of interest to the public. As always, we sug-gest
that licensees consult with their private legal counsel
regarding any questions about whether and how new leg-islation
affects their practice.
__________________________
1Now Session Law 2007-346 and available at www.ncleg.net.
2The Review Panel will not make recommendations regarding the eighth
physician seat that must go to a DO, academic alternative medicine
practitioner or member of the Old North State Medical Society.
3The NCMS will have four members on the Review Panel. The other
organizations represented will have one each.
4Now Session Law 2007-418 and available at www.ncleg.net.
5Now Session Law 2007-489 and available at www.ncleg.net. The effec-tive
date is October 1, 2007. This law does not require that all persons
performing laser hair removal under the supervision of a physician be
licensed by the Electrolysis Examiners.
“The new law, in
Section 6, re-quires
that LHPs
be supervised by a
physician licensed
by the Medical
Board”
No. 3 2007 15
NORTH CAROLINA MEDICAL BOARD
Board Orders/Consent Orders/Other Board Actions
May-June-July 2007
DEFINITIONS:
Annulment:
Retrospective and prospective cancellation of the practitioner’s
authorization to practice.
Conditions:
A term used in this report to indicate restrictions, requirements,
or limitations placed on the practitioner.
Consent Order:
An order of the Board stating an agreement between the Board
and the practitioner regarding the annulment, revocation, sus-pension,
or surrender of the authorization to practice, or the
conditions placed on the authorization to practice, or other ac-tion
taken by the Board relative to the practitioner. (A method
for resolving a dispute without a formal hearing.)
Denial:
Final decision denying an application for practice authoriza-tion
or a request for reconsideration/modification of a previous
Board action.
Dismissal:
Board action dismissing a contested case.
Inactive Medical License:
To be “active,” a medical license must be registered on or near
the physician’s birthday each year. By not registering his or her
license, the physician allows the license to become “inactive.”
The holder of an inactive license may not practice medicine in
North Carolina. Licensees will often elect this status when they
retire or do not intend to practice in the state. (Not related to the
“voluntary surrender” noted below.)
NA:
Information not available or not applicable.
NCPHP:
North Carolina Physicians Health Program.
Public Letter of Concern:
A letter in the public record expressing the Board’s concern
about a practitioner’s behavior or performance. Concern has
not risen to the point of requiring a formal proceeding but
should be known by the public. If the practitioner requests a
formal disciplinary hearing regarding the conduct leading to the
letter of concern, the letter will be vacated and a formal com-plaint
and hearing initiated.
Reentry Agreement:
Arrangement between the Board and a practitioner in good
standing who is “inactive” and has been out of clinical practice
for two years or more. Permits the practitioner to resume active
practice through a reentry program approved by the Board to
assure the practitioner’s competence.
RTL:
Resident Training License. ( Issued to those in post-graduate
medical training who have not yet qualified for a full medical
license.)
Revocation:
Cancellation of the authorization to practice. Authorization
may not be reissued for at least two years.
Stay:
The full or partial stopping or halting of a legal action, such as
a suspension, on certain stipulated grounds.
Summary Suspension:
Immediate withdrawal of the authorization to practice prior to
the initiation of further proceedings, which are to begin within
a reasonable time. (Ordered when the Board finds the public
health, safety, or welfare requires emergency action.)
Suspension:
Withdrawal of the authorization to practice for a stipulated
period of time or indefinitely.
Temporary/Dated License:
License to practice for a specific period of time. Often ac-companied
by conditions contained in a Consent Order.
May be issued as an element of a Board or Consent Order or
subsequent to the expiration of a previously issued temporary
license.
Voluntary Surrender:
The practitioner’s relinquishing of the authorization to practice
pending or during an investigation. Surrender does not pre-clude
the Board bringing charges against the practitioner. (Not
related to the “inactive” medical license noted above.)
For the full text version of each summary and for public documents, please visit the Board’s Web site at www.ncmedboard.org
ANNULMENTS
NONE
REVOCATIONS
EATON, Hubert Arthur, Jr, MD
Location: Wilmington, NC (New Hanover Co) | DOB: 5/25/1943
License #: 0000-17858 | Specialty: IM (as reported by physician)
Medical Ed: Meharry Medical College (1969)
Cause: Dr Eaton has a history of substance abuse. In June 2006, a
urine sample showed Dr Eaton had consumed alcohol in vi-olation
of his March 2005 Consent Order and his NCPHP
contract.
Action: 6/08/2007. Findings of Fact, Conclusions of Law, and Or-der
of Discipline issued following hearing on 4/18/2007:
Dr Eaton’s North Carolina medical license is revoked.
MILLER, Shelly Ann, MD
Location: Raleigh, NC (Wake Co) | DOB: 7/13/1965
License #: 0095-01008 | Specialty: FP (as reported by physician)
Medical Ed: University of Connecticut (1991)
Cause: The NCPHP determined that Dr Miller, who had an
NCPHP contract, was not able to maintain control of her
abuse of mood-altering substances. In May 2006, the
NCPHP recommended she surrender her medical license,
which she did on 6/13//2006. Dr Pendergast testified Dr
Miller did not appear to be clinically stable.
Action: 6/20/2007. Findings of Fact, Conclusions of Law, and Or-der
of Discipline issued following hearing on 6/20/2007 to
consider the recommendation of a hearing panel held on
2/21/2007: Dr Miller’s North Carolina medical license is
revoked.
TROGDON, James Clifford, Nurse Practitioner
Location: Chapel Hill, NC (Orange Co) | DOB: 10/19/1957
Approval #: 0002-01033
NP Education: NA
Cause: The Board received information that during 2005 and
2006, Mr Trogdon forged a physician’s signature on mul-tiple
prescriptions for a controlled substance and gave the
medication to one or more family members. When con-fronted,
he admitted the conduct and surrendered his ap-proval
as an NP on April 5, 2006. He later admitted he had
taken the medications himself.
Action: 6/20/2007. Findings of Fact, Conclusions of Law, and Or-der
of Discipline issued following hearing on 6/20/2007:
Mr Trogdon’s North Carolina NP approval is revoked.
See Consent Orders:
BRYDON, Kim Marie, MD
SUSPENSIONS
HARRIS-CHIN, Cheryl Jacqueline, MD
Location: Charlotte, NC (Mecklenburg Co) | DOB: 3/25/1963
License #: 2002-00914 | Specialty: PD (as reported by physician)
Medical Ed: University of the West Indies (1988)
Cause: The Maryland Board suspended Dr Harris-Chin’s license for
six months in April 2006. It had determined she improperly
accessed medical records, requested a consultation on a ficti-tious
patient, and failed to notify the Board of her change of
address. It also concluded her denial to the Board concern-ing
the issues was unprofessional.
Action: 6/06/2007. Findings of Fact, Conclusions of Law, and Or-der
of Discipline issued following hearing on 4/18/2007:
Dr Harris-Chin’s North Carolina medical license is suspend-ed
for six months.
TERRY, Sandra Louise, Nurse Practitioner
Location: Hope Mills, NC (Sampson Co) : DOB: 3/20/1971
Approval #: 0002-01963
NP Education: NA
Cause: The Nursing Board summarily suspended Ms Terry’s nurs-ing
license in July 2006 based on a history of several convici-tions
for DUI and for eluding arrest in a motor vehicle. On
July 21, 2006, the Nursing Board confirmed its suspension
decision. In April 2007, the Medical Board filed charges
16 NCMB Forum
based on the actions of the Nursing Board.
Action: 7/10/2007. Findings of Fact, Conclusions of Law, and Or-der
of Discipline issued following hearing on 6/20/2007:
Ms Terry’s North Carolina nurse practitioner approval is
suspended indefinitely.
See Consent Orders:
BASAMANIA, Beth P., MD
BLAKE, John Alder, Physician Assistant
CARBONE, Dominick J., Jr, MD
GUARINO, Clinton Toms Andrews, MD
HILL, Monica Rae, DO
HOPE, Shelly-Ann Violet, MD
JOHANSEN, James Richard, MD
MARTIN, Michele I., MD
McKEEL, Cameron Roberts, Physician Assistant
MOCLOCK, Michael Anthony, MD
MORTER, Gregory Alan, MD
NG, Chun-Ho Patrick, MD
STEINER, Drew John, MD
REYNOLDS, Robert Jack, MD
SUMMARY SUSPENSIONS
NONE
CONSENT ORDERS
BASAMANIA, Beth P., MD
Location: Chapel Hill, NC (Orange Co) | DOB: 3/31/1963
License #: 0099-00323 | Specialty: FP (as reported by physician)
Medical Ed: George Washington University (1990)
Cause: Dr Basamania prescribed numerous prescriptions for non-controlled
substances to herself and kept no record of those
prescriptions. She also abused Ultram®. During this time
she did not practice clinical medicine. In June 2006, she
surrendered her medical license.
Action: 7/19/2007. Consent Order executed: Dr Basamania’s
North Carolina medical license is indefinitely suspended.
BENTLEY, Susan Warren, Nurse Practitioner
Location: Huntersville, ND (Mecklenburg Co) | DOB:
7/19/1954
Approval #: 0009-40101
NP Education: NA
Cause: Ms Bentley was asked for a copy of her collaborative prac-tice
agreement with Dr Joseph Jemsek in July 2006. She
provided a document titled “2005 Collaborative Practice
Agreement for Nurse Practitioners at Jemsek Clinic” that in-dicated
it was created in October 2005. The document was
not properly signed or dated by Ms Bentley or Dr Jemsek.
Another nurse practitioner at the clinic indicated no such
agreement was in place in 2004. Earlier documents, called
“protocols” did not comply with the spirit and letter of the
law at that time.
Action: 5/23/2007. Consent Order executed: Ms Bentley is repri-manded.
BLAKE, John Alder, Physician Assistant
Location: Wilmington, NC (New Hanover Co) | DOB: 3/05/1971
License #: 0001-03290
PA Education: The College of West Virginia (2001)
Cause: Mr Blake, operating his own medical practice without a
physician on site to supervise, mismanaged the care of four
patients. Proper consultation with his supervising physician
would most likely have prevented the problems of misman-agement
of his patients. He has no previous disciplinary
history and has taken significant CME. His supervising
physician has developed a remediation plan concerning the
issues in the case and Mr Blake has implemented an elec-tronic
medical records system for all his patients. All but one
of the patients involved continue treatment by Mr Blake.
Action: 6/18/2007. Consent Order executed: Mr Blake’s PA license
is suspended for one year; suspension is stayed and he is
placed on probation on terms and conditions; he shall have
on-site supervision and meet with his primary supervising
physician on a weekly basis for six months; he shall submit
himself to the Center for Personalized Education for Physi-cians
by July 31, 2007, for assessment and provide resulting
reports to the Board; must comply with other requirements
related to the issues of the case.
BRYDON, Kim Marie, MD
Location: Raleigh, NC (Wake Co) | DOB: 11/06/1957
License #: 0000-33795 | Specialty: P (as reported by physician)
Medical Ed: University of Kansas (1987)
Cause: Dr Brydon had a sexual relationship with a patient. When
working for the North Carolina Correctional Institute for
Women, Dr Brydon began treating an inmate for mental
problems in 2001. A year after being released from NC-CIW,
the patient moved in with Dr Brydon and they be-gan
a sexual relationship. The patient was later reincarcer-ated
based on her obtaining prescription drugs by forging
Dr Brydon’s name on prescription blanks from one of Dr
Brydon’s old prescription pads. Dr Brydon saw the patient
again after the patient was readmitted to NCCIW. Dr Bry-don
has admitted this was inappropriate but she did it in
an effort to conceal the relationship they had. Dr Brydon
voluntarily surrendered her license in April 2007.
Action: 6/26/2007. Consent Order executed: Dr Brydon’s North
Carolina medical license is revoked.
CARBONE, Dominick J., Jr, MD
Location: Winston-Salem, NC (Forsyth Co) | DOB: 8/09/1965
License #: 0097-00498 | Specialty: US (as reported by physician)
Medical Ed: University of Michigan Medical School (1990)
Cause: Application for reinstatement of license. From December
2005 to March 2006, Dr Carbone had a consensual sexual
relationship with a patient. He ceased practice in Decem-ber
2006 and surrendered his license in January 2007. His
license was indefinitely suspended in 2007 via Consent Or-der.
He has completed an in-depth evaluation at the Profes-sional
Renewal Center in Kansas and has a contract with the
NCPHP.
Action: 7/01/2007. Consent Order executed: Dr Carbone is is-sued
a license; that license is suspended and suspension is
stayed on probationary terms; he shall maintain and abide
by a contract with the NCPHP; must comply with other
conditions.
COLLINS, Paul Dwayne, MD
Location: Pembroke, NC (Robeson Co) | DOB: 2/08/1973
License #: 2005-00139 | Specialty: FP (as reported by physician)
Medical Ed: Wake Forest University School of Medicine (2001)
Cause: On application to reinstate license. Because of his history
of alcohol and substance abuse, Dr Collins entered a Con-sent
Order with the Board in 2005 to obtain a license. In
February 2006, he tested positive for alcohol, violating his
Consent Order and his contract with the NCPHP. He sur-rendered
his license in March. Since July 2006, he has un-dergone
weekly therapy and attends AA. He reports he has
abstained from alcohol and mind-altering substances since
that time. He has a five-year contract with the NCPHP and
the NCPHP reports he is in compliance.
Action: 5/25/2007. Consent Order executed: Dr Collins is is-sued
a license to expire on the date shown on the license
[6/30/2007]; he shall be on probation for 12 months; he
shall maintain and abide by a contract with the NCPHP; he
shall attend AA and/or NA meetings weekly; he shall work
no more than 40 hours per week and shall not take call,
he shall abide by all recommendations of his treatment pro-gram
and therapist; unless lawfully prescribed by another
person, he shall refrain from use of all mind- or mood-alter-ing
substances and alcohol; he shall submit to drug/alcohol
No. 3 2007 17
screenings as requested by the Board; must comply with
other conditions.
COOPER, Armah Jamale, MD
Location: Butner, NC (Granville Co) | DOB: 5/28/1956
License #: 0000-29096 | Specialty: P/FRY (as reported by physician)
Medical Ed: Meharry Medical College (1981)
Cause: Dr Cooper has, on occasion, prescribed for himself for his
epilepsy when prescriptions from his physician in Maryland
were delayed. To do this, he wrote prescriptions in the name
of a friend, taking the drug himself. He has been evaluated
by the NCPHP and does not appear to have an abuse prob-lem.
He has also enrolled in a prescribing course and has
been referred to appropriate physicians for his care.
Action: 7/09/2007. Consent Order executed: Dr Cooper is repri-manded.
COULSON, Alan Stewart, MD
Location: Hamlet, NC (Richmond Co) | DOB: 6/21/1941
License #: 2000-01476 | Specialty: VS (as reported by physician)
Medical Ed: Guy’s Hospital Medical School, UK (1970)
Cause: Dr Coulson’s cardiac surgical privileges were suspended at
his hospital. Review of the charts of four of his patients
for the Board by an outside expert noted Dr Coulson failed
to meet acceptable standards in three of the cases. Review
of the charts of five vascular surgical patients by an outside
expert indicated appropriate care.
Action: 6/20/2007. Consent Order executed: Dr Coulson’s license
is limited: he shall not perform cardiac surgery in North
Carolina; he agrees to periodic chart review; must comply
with other conditions.
DASSO, Edwin Joseph, MD
Location: Greensboro, NC (Guilford Co) | DOB: 6/26/1955
License #: 2007-01165 | Specialty: AN (as reported by physician)
Medical Ed: University of Texas Southwestern Med Center, Dallas
(1983)
Cause: Dr Dasso holds licenses in several states and has not prac-ticed
clinical medicine since 1994. He works as a medical
director for insurance companies. He has no plans to prac-tice
clinical medicine in North Carolina.
Action: 7/11/2007. Consent Order executed: Dr Dasso is issued
a limited administrative license that requires he not practice
clinical medicine; should he decide to resume clinical prac-tice,
the Board president must approve a plan for updating
his skills and his practice site.
DAVIDSON, Arthur Turner, Jr, MD
Location: New York, NY | DOB: 8/30/1947
License #: 2007-00917 | Specialty: NA
Medical Ed: Howard College of Medicine (1975)
Cause: Dr Davidson signed a Consent Order with the New York
Board accepting a censure and reprimand, agreeing to take a
targeted CME course, and agreeing to a two-year probation
as a result of prescribing for his wife during her pregnancy.
He has completed the terms of his agreement with New
York and holds a medical license there. This North Caro-lina
Consent Order is intended only to make Dr Davidson’s
New York record a matter of public record in North Caro-lina.
Action: 6/05/2007. Non-Disciplinary Consent Order executed: Dr
Davidson is issued a North Carolina medical license.
DAUITO, Ralph, MD
Location: Vineland, NJ | DOB: 3/31/1956
License #: 2007-01012 | Specialty: R (as reported by physician)
Medical Ed: Georgetown University School of Medicine (1984)
Cause: On appeal of a license denial. Dr Dauito signed a Consent
Order with the New Jersey Board in December 2001 admit-ting
to certain findings regarding his treatment of a patient.
He failed to diagnose a pseudoaneurysm because he did
not view all of the X-rays. Later, he made the diagnosis but
failed to inform the patients physician. He was reprimand-ed
and required to take ethics course and an angiography
course, and pay a fine. His license was suspended with a stay
based on his compliance with conditions placed on him. He
agrees to abide by the conditions set in New Jersey in North
Carolina. A North Carolina license is granted on conditions
set forth in the following Consent Order.
Action: 6/18/2007. Consent Order executed: Dr Dauito is repri-manded
as a reciprocal action to the New Jersey reprimand;
he shall have an audit of his practice to determine the hours
he works, the number of patients he sees per week, and the
types of radiology he performs; the North Carolina Board
president will review the audit results to determine if any
limits should be put on Dr Dauito’s practice; he must com-ply
with other conditions.
GREER, Gary Wayne, MD
Location: Hickory, NC (Catawba Co) | DOB: 9/17/1953
License #: 0096-01621 | Specialty: EM (as reported by physician)
Medical Ed: Harvard Medical School (1979)
Cause: Dr Greer wrote prescriptions for himself and a patient with
whom he had a close family relationship. He made no
medical record in either case. It does not appear that the
drugs prescribed were inappropriate for his or his relative’s
medical conditions. He was not aware of the restrictions on
such prescribing and has placed himself under the care of a
personal physician. The relative has also been placed under
the care of a personal physician. Dr Greer has practiced for
27 years without any other Board action against him. He
will take remedial training related to the prescribing issue.
Action: 6/20/2007. Consent Order executed: Dr Greer’s license
is cited with a Public Letter of Concern; he shall comply
with the relevant Board position statements and shall attend
a prescribing course within 12 months; must comply with
other conditions.
GUARINO, Clinton Toms Andrews, MD
Location: Hickory, NC (Catawba Co) | DOB: 2/04/1966
License #: 0099-00062 | Specialty: IM (as reported by physician)
Medical Ed: Wake Forest University School of Medicine (1996)
Cause: In 2005, Dr Guarino voluntarily surrendered his North
Carolina medical license as a result of his arrest for traffic
offenses and evidence that he suffered a substance abuse/de-pendency
condition. In January 2006, he entered into a
Consent Order with the Board suspending his medical li-cense.
In September 2006, he pled guilty to DUI, driving
on a restricted license, and felony eluding arrest stemming
from the 2005 incident. In October 2006, he entered a sec-ond
Consent Order with the Board reinstating his license on
a temporary basis with conditions related to his situation.
In November, Dr Guarino tested positive for drug use on
screenings by the Board and the NCPHP. On December 7,
2006, he surrendered his license.
Action: 6/18/2007. Consent Order executed: Dr Guarino’s North
Carolina medical license is indefinitely suspended; he may
not apply for reinstatement for at least one year.
HARRELL, Raymond Martin, MD
Location: Chapel Hill, NC (Orange Co) | DOB: 7/13/1975
License #: RTL | Specialty: AN (as reported by physician)
Medical Ed: University of North Carolina School of Medicine (2007)
Cause: Dr Harrell has a history of substance and alcohol abuse. He
sought help at an inpatient facility and has been sober since
2000. He has a monitoring contract with the NCPHP.
Action: 6/21/2007. Consent Order executed: Dr Harrell is is-sued
a resident training license for UNC Hospital; he shall
maintain and abide by a contract with the NCPHP; he shall
meet with the Board as requested and shall provide a letter
from his program director evaluating his performance; he
shall submit to drug/alcohol screenings as requested by the
Board; unless lawfully prescribed by another person, he shall
refrain from the use or possession of all mind- or mood-altering
substances and controlled substances; must comply
with other conditions.
18 NCMB Forum
HILL, Monica Rae, DO
Location: Lumberton, NC (Robeson Co) | DOB: 1/18/1968
License #: 2003-00805 | Specialty: IM (as reported by physician)
Medical Ed: Des Moines University Osteopathic Medical Center (1998)
Cause: Dr Hill attempted to gain payment for acquired time off for
a friend and former co-worker who had been fired for cause
by the hospital in which Dr Hill worked as a hospitalist. The
hospital did not offer such payments in those situations. She
called the vice president and COO of the hospital, asked the
payment be made as a favor to her, and offered to provide
an expert review that would make the hospital look good if
payment were made. In fact, she had no case in which she
was providing an expert review. She was, in essence, bluff-ing
to assist her former co-worker.
Action: 6/20/2007. Consent Order executed: Dr Hill’s North Car-olina
medical license is suspended for 30 days; suspension is
stayed; she shall obey all laws and regulations related to the
practice of medicine.
HOPE, Shelly-Ann Violet, MD
Location: Lenoir, NC (Caldwell Co) | DOB: 9/23/1963
License #: 2003-00157 | Specialty: OB/GYN (as reported by physi-cian)
Medical Ed: Howard University (1990)
Cause: Dr Hope issued prescriptions to patients without first per-forming
a physical examination. From May to September
2006, she provided medical services for one John Garcia
through Inetmedic.com, a business that renders medical
services via the Internet. He told her as long as she was
licensed in North Carolina she need not be licensed else-where.
She issued numerous prescriptions without physical
examinations and allowed Inetmedic to bill patients for her
services. She was paid $25 per patient. From October 2006
to March 2007, she contracted with Juan Ibanez, MD, to
provide medical services through online companies owned
by him. Again, she authorized numerous prescriptions
without examining patients. She allowed Ibanez to bill pa-tients
for her services and she was paid $5,000 per month.
She admits that she was assisting in the unlicensed practice
of medicine in North Carolina by Ibanez and his group, and
by Garcia and his group.
Action: 6/20/2007. Consent Order executed: Dr Hope’s North
Carolina medical license is suspended for 90 days; suspen-sion
is stayed on probationary terms and conditions; she
shall comply with the Board’s position statements on pre-scribing
and within 12 months she shall take and complete
a course on prescribing; she shall not prescribe without per-forming
a physical examination and she shall not assist any
person or entity in the unlicensed practice of medicine in
North Carolina; must comply with other conditions.
HUMBLE, Scott David, MD
Location: Raleigh, NC (Wake Co) | DOB: 9/28/1970
License #: 2007-00897 | Specialty: PTH (as reported by physician)
Medical Ed: Wake Forest University School of Medicine (1998)
Cause: Dr Humble recognized he was abusing alcohol during
postgraduate training in Florida and voluntarily entered the
Florida Professionals Resource Network with a five-year
monitoring contract. In October 2006, he entered a con-tract
with the NCPHP, which did not express reservations
about his ability to practice safely.
Action: 5/30/2007. Consent Order executed: Dr Humble is issued
a medical license [to expire 11/30/2007]; he shall maintain
and abide by his NCPHP contract; he shall submit to drug/
alcohol screenings as requested by the Board; unless lawfully
prescribed by another person, he shall refrain from the use
or possession of all mind- or mood-altering substances and
controlled substances, including alcohol; must comply with
other conditions.
JOHANSEN, James Richard, MD
Location: Shelby, NC (Cleveland Co) | DOB: 9/12/1959
License #: 0096-00957 | Specialty: FP (as reported by physician)
Medical Ed: University of California, Irvine (1986)
Cause: In February 2007, Dr Johansen abruptly and without notice
to patients closed his practice. He told his staff to stay at the
practice for several days so they could inform patients with
appointments that the practice was closed. He informed the
Board that a domestic situation had caused him to close his
practice and asked guidance. He did not mail notices to pa-tients
nor provide his patients information on how to obtain
their records. A Board investigator visited the office loca-tion
and found no contact information or instructions for
patients, though there were 10 notes from patients stuck in
the door asking for their records. Complaints were received
by the Board as late as March 16, 2007, about being unable
to obtain records. The Board contacted Dr Johansen and
told him to facilitate informing all patients about obtain-ing
records. He reports he did as requested. Investigation
found this to be true. Dr Johansen has kept the Board in-formed
of his efforts to meet his ethical responsibilities since
that time. A new group has taken over the practice and it
has reopened.
Action: 6/20/2007. Consent Order executed: Dr Johansen’s North
Carolina medical license is suspended for two years as of
5/01/2007; suspension will be stayed as of 6/15/2007 and
he is placed on probation on terms and conditions; he shall
obey all laws and regulations related to medical practice and
comply with all ethical responsibilities regarding closing of
his practice; must comply with other conditions.
JONES, Robert Glen, MD
Location: Raleigh, NC (Wake Co) | DOB: 4/06/1959
License #: 0094-00536 | Specialty: OSM/SM (as reported by physi-cian)
Medical Ed: Emory University School of Medicine (1988)
Cause: On application for license reinstatement. Dr Jones surren-dered
his license in June 2006 and his license was suspended
by consent order in September 2006 as a result of his alcohol
abuse. The NCPHP reported he has been in compliance
with his NCPHP contract and there is no evidence patient
care was compromised by his use of alcohol.
Action: 7/26/2007. Consent Order executed: Dr Jones’ is issued
a temporary/dated license to expire on the date shown on
the license [11/30/2007]; he shall maintain and abide by
a contract with the NCPHP; unless lawfully prescribed by
someone else, he shall not use mind- or mood-altering sub-stances,
controlled substances, or alcohol and shall notify
the Board if and when such are prescribed; he shall supply
hair and/or bodily fluids for screening as requested by the
Board; he shall attend AA or Caduceus meetings; must
comply with other conditions.
MARTIN, Michele I., MD
Location: Statesville, NC (Iredell Co) | DOB: 5/20/1965
License #: 0096-01667 | Specialty: GP/P (as reported by physician)
Medical Ed: Loma Linda University (1994)
Cause: Between April 2003 and July 2006, Dr Martin had an inti-mate
relationship with Patient A but did not end their exist-ing
patient-physician relationship. She continued to give
treatment, including prescribing controlled medications, to
Patient A. From early 1999 to early 2002, she also wrote
prescriptions for Patient B, a family member.
Action: 6/19/2007. Consent Order executed: Dr Martin’s North
Carolina medical license is suspended for six months; sus-pension
is stayed on probationary terms; she shall attend the
Vanderbilt courses on prescribing controlled substances and
on maintaining proper boundaries within 12 months; she
shall maintain and abide by a contract with the NCPHP; she
shall perform 100 hours of community service approved by
the Board president; must comply with other conditions.
McKEEL, Cameron Roberts, Physician Assistant
Location: Asheville, NC (Buncombe Co) | DOB: 1/09/1968
No. 3 2007 19
License #: 0001-03586
PA Education: NA
Cause: Mr McKeel has a significant criminal history with previous
convictions for DUI, possession of drug paraphernalia, and
breaking and/or entering. In October 2006, he was arrested
in South Carolina and charged with illegal possession of
prescription medication, which he later admitted to Board
investigators. He also admitted possession of marijuana
and chronic alcohol use. A urine sample in December 2006
was positive for amphetamine, marijuana, and alcohol. In
October 2006, Mr McKeel was also arrested in Buncombe
County for felony assault by strangulation and misdemeanor
assault on a female. He later admitted to Board investiga-tors
that he did touch the alleged female victim’s neck and
head.
Action: 5/30/2007. Consent Order executed: Mr McKeel’s PA li-cense
is suspended indefinitely.
MOCLOCK, Michael Anthony, MD
Location: Dubois, PA | DOB: 11/18/1951
License #: 2007-01013 | Specialty: FP (as reported by physician)
Medical Ed: Medical College of Pennsylvania (1990)
Cause: On application for a North Carolina license. Dr Moclock
entered into a Consent Agreement with the Pennsylvania
Board in 2006 in which he admitted he abused alcohol and
suffered active alcohol dependency from 1999 to 2001 and
self-prescribed cough syrup with hydrocodone in 2001. He
voluntarily sought treatment in 2004 and later in 2004 re-lapsed.
He is now participating in the PHMP monitoring
program. In 2006, he was assessed by the NCPHP, which
has no reservations about his ability to practice safely.
Action: 6/14/2007. Consent Order executed: Dr Moclock is issued
a North Carolina medical license; his license is suspended
indefinitely, suspension is stayed on terms and conditions, he
is placed on probation for three years; he shall abide by the
terms of the Pennsylvania Consent Order and shall enter a
five-year contract with the NCPHP and abide by its terms;
he shall submit to drug/alcohol screenings as requested by
the Board; unless lawfully prescribed by another person,
he shall refrain from the use of all mind- or mood-altering
substances, controlled substances, and alcohol; must comply
with other conditions, must comply with other conditions.
MORTER, Gregory Alan, MD
Location: Wilmington, NC (New Hanover Co) | DOB: 12/03/1959
License #: 0000-36401 | Specialty: PD (as reported by physician)
Medical Ed: University of Pittsburgh (1986)
Cause: Dr Morter has a history of substance abuse. In 2005, he
entered a Consent Order with the Board requiring he report
to the Board and the NCPHP any prescription he might re-ceive
for mind- or mood-altering substances, but he did not
notify the Board or the NCPHP when a hydrocodone-con-taining
cough syrup was prescribed by his physician. He did
not disclose his use of this prescription when asked about
drug use recently and when a routine drug screen was done.
In February 2007, he admitted to a Board investigator that
he abused hydrocodone after a difficult court date involving
a domestic situation. He surrendered his medical license in
April 2007.
Action: 7/17/2007. Consent Order executed: Dr Morter’s North
Carolina medical license is suspended indefinitely.
NG, Chun-Ho Patrick, MD
Location: Kannapolis, NC (Cabarrus Co) | DOB: 4/06/1959
License #: 0000-32813 | Specialty: FP (as reported by physician)
Medical Ed: Medical College of Georgia (1985)
Cause: Expert review of five patient charts revealed Dr Ng’s docu-mentation
of care and ongoing treatment and management
of medications was below the standard of care. The expert
indicated this failing was in part a symptom of Dr Ng’s reli-ance
on electronic recordkeeping. The expert also concluded
Dr Ng’s failure to use pain contracts in treatment of chronic
pain patients was below the standard of care. Kannapolis
police charged him with unlawfully dispensing a controlled
substance without finding a medical reason. The Board
summarily suspended his medical license on 2/22/2007.
Many of his colleagues have written the Board attesting to
his competence and professionalism.
Action: 7/20/2007. Consent Order executed: Dr Ng’s medical
license is suspended for five months, running retroactively
from 2/22/2007; at the end of the five months, he may re-turn
to practice under probationary terms related to record-keeping
and proper prescribing; must comply with other
conditions.
PUSEY, Tanya Terese, Nurse Practitioner
Location: Huntersville, NC (Mecklenburg Co) | DOB:
4/27/1970
Approval #: 0002-01713
NP Education: Clemson University (2002)
Cause: Ms Pusey worked for Dr Joseph Jemsek between 2003 and
2005. The Board asked her for a copy of her collaborative
practice agreement with Dr Jemsek in July 2006. She pro-vided
what she termed a protocol agreement because col-laborative
agreements were not in place at the time of her
employment. The “protocol” was not properly signed or
dated by Ms Pusey or Dr Jemsek and did not comply with
the spirit and letter of the law at that time.
Action: 5/21/2007. Consent Order executed: Ms Pusey is repri-manded.
REYNOLDS, Robert Jack, MD
Location: Knoxville, TN | DOB: 12/09/1953
License #: 0000-27968 | Specialty: AM/IM (as reported by physi-cian)
Medical Ed: University of Tennessee (1980)
Cause: In April 2005, Dr Reynolds pled guilty to DUI in Colorado
and the next year he pled guilty to DUI in Buncombe Coun-ty,
NC. Following these convictions, he entered a contract
with the NCPHP. In March 2006, Dr Reynolds tested posi-tive
for alcohol, having failed to call the NCPHP to check
on the need for urine screens earlier as required. He says his
failure to call the NCPHP was an oversight. Dr Reynolds
has not practiced clinical medicine since 2000. He admits
that when abusing alcohol he is unable to practice appropri-ately.
Action: 6/05/2007. Consent Order executed: Dr Reynolds’ North
Carolina medical license is suspended for four months; sus-pension
is stayed on terms and conditions; he shall maintain
and abide by his NCPHP contract; he shall submit to drug/
alcohol screenings as requested by the Board; he shall pro-vide
a copy of this Consent Order to all current and prospec-tive
employers; unless lawfully prescribed by another person,
he shall refrain from the use or possession of all mind- or
mood-altering substances and controlled substances; must
comply with other conditions.
ROESKE, Christie Furr, Nurse Practitioner
Location: Belmont, NC (Gaston Co) | DOB: 9/28/1971
Approval #: 0002-01176
NA Education: NA
Cause Ms Roeske was employed by the Jemsek Clinic and was su-pervised
by Dr Joseph G. Jemsek from 2002 to 2007. In
July 2006, she was asked to provide the Board a copy of
her Collaborative Practice Agreement with Dr Jemsek. She
provided a document that noted it was created in October
2005. It was neither signed nor dated. Another nurse prac-titioner
at the clinic indicated no such document existed in
2004 when she began work. The Board found that docu-ments
that did exist did not meet the requirements of the
rules and regulations.
Action: 5/23/2007. Consent Order executed: Ms Roeske is repri-manded.
SKELTON, Henry Grady, III, MD
20 NCMB Forum
Location: Tucker, GA | DOB: 6/09/1951
License #: 2004-00265 | Specialty: PTH/DMPD (as reported by phy-sician)
Medical Ed: Medical College of Georgia (1979)
Cause: In September 2006, the Georgia Board reinstated Dr Skel-ton’s
Georgia license, issuing a fine and a reprimand as a
result of his practicing without a valid license because he
failed to renew his license on the appropriate date.
Action: 5/17/2007. Consent Order executed: Dr Skelton is repri-manded.
SMILEY, Margaret Lynn, MD
Location: Durham, NC (Durham Co) | DOB: 7/11/1952
License #: 0000-28347 | Specialty: ID/IM (as reported by physician)
Medical Ed: Duke University School of Medicine (1978)
Cause: Dr Smiley has not practiced clinical medicine since 1988
and her position with a pharmaceutical company does not
involve clinical practice. She has had an inactive license and
now applies for a limited administrative license.
Action: 7/13/2007. Non-Disciplinary Consent Order executed: Dr
Smiley is granted a limited administrative license that re-quires
she not practice clinical medicine in North Carolina.
SMITH, Kathleen Jeanne, MD
Location: Tucker, GA | DOB: 3/06/1951
License #: 2004-00601 | Specialty: D/DMP (as reported by physi-cian)
Medical Ed: University of Iowa College of Medicine (1975)
Cause: Dr Smith’s Georgia license was reinstated in 2006 via a
Consent Order. She was fined and reprimanded for practic-ing
without a license because she failed to renew her license
on the appropriate date.
Action: 5/22/2007. Consent Order executed: Dr Smith is repri-manded.
STEINER, Drew John, MD
Location: Elkin, NC (Surry Co) | DOB: 12/03/1962
License #: 0099-01479 | Specialty: FP/EM (as reported by physician)
Medical Ed: Georgetown University (1989)
Cause: Dr Steiner has an alcohol abuse problem. He surrendered
his medical license in January 2007 and entered an inpatient
treatment program, which he completed successfully in May
2007. He has a five-year contract with the NCPHP. There
is no evidence his care of patients was ever compromised by
his use of alcohol.
Action: 7/30/2007. Consent Order executed: Dr Steiner’s medi-cal
license is indefinitely suspended as of 1/10/ 2007; must
comply with certain conditions.
WALDMAN, Richard Alan, MD
Location: Whiteville, NC (Columbus Co) | DOB: 4/07/1942
License #: 0000-39134 | Specialty: PD (as reported by physician)
Medical Ed: New York University (1968)
Cause: A review of the medical records of seven of Dr Waldman’s
patients showed he failed to maintain coherent and accurate
records. He also failed to meet the Board’s CME require-ment
for the three-year period 2002-2004.
Action: 6/05/2007. Consent Order executed: Dr Waldman is rep-rimanded;
he shall comply with the Board’s Position State-ment
on Medical Record Documentation; he shall attend
and satisfactorily complete an intensive course on record
keeping; he shall complete 20 hours of Category I CME
within one year; must comply with other requirements.
WEED, Barry Christopher, MD
Location: Raleigh, NC (Wake Co) | DOB: 7/06/1969
License #: 2002-00625 | Specialty: P (as reported by physician)
Medical Ed: East Carolina University School of Medicine (1998)
Cause: Dr Weed has a history of alcohol and substance abuse. As a
result, he entered a contract with the NCPHP after gradu-ation
from medical school. Although the Board received
favorable reports from the NCPHP regarding Dr Weed,
he began to think he could drink safely in moderation. In
2005, he had a single-vehicle accident and was charged with
DUI. He disclosed this incident to the Board, but a crimi-nal
record check revealed certain misdemeanor convictions
he did not disclose on his application for a license in 2002.
He believed those incidents, happening when he was a teen-ager,
did not have to be noted. In June 2006, he entered
inpatient treatment for his substance abuse, which he suc-cessfully
completed. He voluntarily surrendered his North
Carolina medical license in November 2006. He has now
applied for reinstatement.
Action: 6/08/2007. Consent Order executed: Dr Weed’s license is
reinstated subject to conditions and said license will expire
on the date shown on the license [12/08/2007]; he shall
maintain and abide by his NCPHP contract; he shall sub-mit
to drug/alcohol screenings as requested by the Board;
he shall provide a copy of this Consent Order to all current
and prospective employers; unless lawfully prescribed by an-other
person, he shall refrain from the use or possession of
all mind- or mood-altering substances and controlled sub-stances;
must comply with other conditions.
WILLIAMS, Jason Anthony, Physician Assistant
Location: Wake Forest, NC (Wake Co) | DOB: 3/11/1974
License #: 0001-02539
PA Education: Methodist College (1998)
Cause: The Board found Mr Williams had prescribed controlled
substances to a patient his supervising physician had dis-charged
and to another his supervising physician had direct-ed
was to get no narcotics. It also found he did not, on one
occasion, have a statement of supervisory arrangement and,
on one occasion, practiced before submitting his Notice of
Intent to Practice. He promptly corrected the deficiencies in
his compliance when these were called to his attention.
Action: 5/18/2007. Consent Order executed: Mr Williams is repri-manded.
YOUNG, Jordon Terrell, MD
Location: Winterville, NC (Pitt Co) | DOB: 3/06/1972
License #: 2007-01009 | Specialty: IM (as reported by physician)
Medical Ed: Medical University of the Americas, Nevis, West Indies
(2003)
Cause: On application for a license. Dr Young has a history of alco-hol
and drug use. He did not include convictions for pos-session
of controlled substances and probation violation on
his application because he believed it was not necessary since
he received a pardon for the offenses from the Governor of
Florida. He is under contract with the NCPHP and has un-dergone
residential inpatient treatment. He is in compliance
with his NCPHP contract.
Action: 6/15/2007. Consent Order executed: Dr Young is is-sued
a license to expire on the date shown on the license
[12/15/2007]; he is reprimanded; he shall maintain and
abide by his NCPHP contract; he shall submit to drug/al-cohol
screenings as requested by the Board; unless lawfully
prescribed by another person, he shall refrain from the use
of all mind- or mood-altering substances , controlled sub-stances,
and alcohol; the Board endorses issuance of DEA
prescribing privileges to him; he must comply with other
conditions.
MISCELLANEOUS ACTIONS
NONE
DENIALS OF RECONSIDERATION/MODIFICATION
NONE
DENIALS OF LICENSE/APPROVAL
BOWMAN, James Thomas, MD
Location: North Wilkesboro, NC (Wilkes Co) | DOB: 11/16/1951
License #: 0000-21742 | Specialty: FP (as reported by physician)
Medical Ed: Bowman Gray School of Medicine (1977)
No. 3 2007 21
Cause: Dr Bowman’s application is denied on the basis of his past
history with the Board, his criminal history, and his proba-tion
violation in 2003.
Action: 6/04/2007. Letter issued denying Dr Bowman’s applica-tion
for reinstatement of his North Carolina medical license.
[Hearing is scheduled on this action for 8/15/2007.]
VINCENT, Robert Allen, MD
Location: Fitchburg, WI | DOB: 5/15/1944
License #: NA | Specialty: R (as reported by physician)
Medical Ed: University of Wisconsin Medical School (1970)
Cause: An appeal of the Board’s earlier decision to deny a license
to Dr Vincent. The Board found the Boards of California,
North Dakota, and Wisconsin had all taken action against
Dr Vincent’s license.
Action: 6/07/2007. Findings of Fact, Conclusions of Law, and Or-der
of Discipline issued following hearing on 4/18/2007:
Denial of Dr Vincent’s application for a North Carolina
medical license was proper and shall remain in effect.
SURRENDERS
AUGUSTINE, Santhosh, MD
Location: Lumberton, NC (Robeston Co) | DOB: 5/30/1960
License #: 0096-00445 | Specialty: NA
Medical Ed: Trivandrum Medical College, India (1985)
Action: 7/24/2007. Voluntary surrender of North Carolina medical
license.
BLISS, Laura Katherine, MD
Location: Mebane, NC (Alamance Co) | DOB: 4/25/1958
License #: 0095-00018 | Specialty: FP (as reported by physician)
Medical Ed: University of North Carolina School of Medicine (1989)
Action: 6/01/2007. Voluntary surrender of North Carolina medical
license.
COLLINS, Paul Dwayne, MD
Location: Pembroke, NC (Robeson Co) | DOB: 2/08/1973
License #: 2005-00139 | Specialty: FP (as reported by physician)
Medical Ed: Wake Forest University School of Medicine (2001)
Action: 7/13/2007. Voluntary surrender of North Carolina medical
license.
McGHEE, James Ernest, MD
Location: Charlotte, NC (Mecklenburg Co) | DOB: 4/25/1953
License #: 0094-00578 | Specialty: FP (as reported by physician)
Medical Ed: Emory University (1988)
Action: 7/23/2007. Voluntary surrender of North Carolina medical
license.
O’DELL, Kevin Bruce, MD
Location: Shelby, NC (Cleveland Co) | DOB: 6/04/1957
License #: 0000-39312 | Specialty: EM (as reported by physician)
Medical Ed: University of Nebraska (1983)
Action: 7/25/2007. Voluntary surrender of North Carolina medical
license.
PYKE, George Albert, MD
Location: Anna Maria, FL | DOB: 9/24/1948
License #: 0096-00690 | Specialty: FP (as reported by physician)
Medical Ed: University of Miami (1975)
Action: 5/09/2007. Voluntary surrender of North Carolina medical
license.
RAPPAPORT, Richard Alan, Physician Assistant
Location: Marion, NC (McDowell Co) | DOB: 4/30/1974
License #: 0001-03970
PA Education: Emory University PA Program (2003)
Action: 5/22/2007. Voluntary surrender of North Carolina PA li-cense.
RATHBURN, Stephen Don, MD
Location: Asheville, NC (Buncombe Co) | DOB: 7/26/1958
License #: 2002-01516 | Specialty: AN (as reported by physician)
Medical Ed: Northeastern Ohio University (1982)
Action: 4/10/2007. Voluntary surrender of North Carolina medical
license.
PUBLIC LETTERS OF CONCERN
BOOKER, James Judson, IV, MD
Location: Forest, VA | DOB: 11/11/1970
License #: 2002-00089 | Specialty: OB/GYN (as reported by physi-cian)
Medical Ed: Medical College of Virginia (1998)
Cause: A Letter of Concern was issued by the Florida Board regard-ing
Dr Booker. He was also fined and required to attend
CME courses in risk management and to perform commu-nity
service. The North Carolina Board is concerned that
Dr Booker left a foreign body in a patient during a surgical
procedure.
Action: 5/09/2007. Public Letter of Concern issued: Dr Booker
is admonished and cautioned that a repetition of such an
incident may lead to disciplinary proceedings.
CABBELL, Kyle Lawrence, MD
Location: Greensboro, NC (Guilford Co) | DOB: 11/05/1964
License #: 0098-00482 | Specialty: NS (as reported by physician)
Medical Ed: Stanford University (1986)
Cause: The Board is concerned that Dr Cabbell performed an ante-rior
cervical diskectomy, arthrodesis and anterior instrumen-tation
at the wrong point.
Action: 6/14/2007. Public Letter of Concern issued: Dr Cabbell is
informed of the Board’s concern about issues of quality of
care and cautions him that a repetition of such an incident
may lead to disciplinary proceedings.
ENNEVER, Peter Robert, MD
Location: Greensboro, NC (Guilford Co) | DOB: 5/19/1960
License #: 0095-00567 | Specialty: HO/IM (as reported by physi-cian)
Medical Ed: George Washington University (1988)
Cause: The Board is concerned that Dr Ennever treated and pre-scribed
Oxycodone to a co-worker, a person with whom he
had a significant emotional relationship.
Action: 5/21/2007. Public Letter of Concern issued: Dr Ennever
is admonished and cautioned that a repetition of such an
incident may lead to disciplinary proceedings.
GOUDARZI, Kamran, MD
Location: Wilmington, NC (New Hanover Co) | DOB:
11/29/1953
License #: 0000-25503 | Specialty: GS/VA (as reported by physician)
Medical Ed: University of London (1978)
Cause: The Board has been notified of a payment made on Dr
Goudarzi’s behalf in resolution of a claim rising out of a sur-gery
in which he removed a patient’s second rib rather than
the intended first rib. The Board recognizes this is a known
risk of such surgery but is concerned treatment of the patient
may have fallen below the standard of care.
Action: 6/14/2007. Public Letter of Concern issued: Dr Goudarzi
is cautioned that a repetition of such an incident may lead to
disciplinary proceedings.
HINDS, David McDonald, Physician Assistant
Location: Goldsboro, NC (Wayne Co) | DOB: 3/05/1947
License #: 0001-00200
PA Education: University of North Carolina (1977)
Cause: Mr Hinds practice three years under supervision of Dr
Charles Land without first filing an intent to practice form
with the Board.
Action: 7/10/2007. Public Letter of Concern issued: The Board is
concerned about such an extended violation of regulations
and cautions Mr Hin